Transcatheter Aortic Valve Implantation in Patients With Super Obesity: Defining a High-Risk Phenotype

The long-term impact of super obesity [body mass index (BMI) ≥50 kg/m²] on outcomes after transcatheter aortic valve implantation (TAVI) is not well defined.

We used the 2015-2020 Nationwide Readmissions Database to identify TAVI procedures and compared patients with super obesity to those with BMI <50 kg/m². Propensity score-matched cohorts were constructed using clinical covariates. We evaluated net adverse cardiovascular events (NACE; composite of in-hospital mortality, stroke, and major bleeding), mortality, and complications during index admission and at 30 and 180 days. A prespecified subgroup analysis compared super-obese with normal-BMI patients.

Among 184,199 TAVI procedures, 4669 patients (2369 super-obese, 2300 nonsuper-obese) were included in the matched cohort. Super-obese TAVI volume increased over time. At index admission, super-obesity was associated with higher odds of NACE [adjusted odds ratio (aOR), 1.57; 95% CI, 1.12-2.20], in-hospital mortality (aOR, 8.08; 95% CI, 3.19-20.48), and acute kidney injury (aOR, 1.48; 95% CI, 1.25-1.74), whereas stroke and major bleeding did not differ. At 30 days, only acute kidney injury remained higher in super-obese patients, and by 180 days, only permanent pacemaker implantation was increased (aOR, 2.55; 95% CI, 1.34-4.85). In subgroup analyses restricted to super-obese versus normal-BMI patients, super-obesity was associated with higher NACE and complications at index admission and 180 days.

Super-obese TAVI recipients have higher early risk and persistent excess risk for selected complications, indicating that extreme obesity defines a higher-risk TAVI phenotype despite broadly comparable longer-term outcomes versus patients with lower BMI.