Does Obesity Impact In-Hospital Outcomes After Transcatheter Mitral Valve Replacement? Insights From the National Inpatient Sample
Sitammagari K, Dontaraju V, Dhanireddy BR, Desai R, Kondamareddy D, Ninan J, and Villablanca P. Does Obesity Impact In-Hospital Outcomes After Transcatheter Mitral Valve Replacement? Insights From the National Inpatient Sample. J Am Coll Cardiol 2019; 74(13):B448.
J Am Coll Cardiol
Background: Transcatheter mitral valve repair (TMVr) is a minimally invasive treatment option for higher surgical risk patients with moderate to severe mitral regurgitation. Multiple studies reported the “obesity paradox” phenomenon in cardiac surgeries and percutaneous interventions; however, no study has explored whether obesity affects in-hospital outcomes after TMVr. Methods: From January 2011 to September 2015, TMVr procedures among adults were identified using the National Inpatient Sample. The determination of obese versus nonobese patients was made by International Classification of Diseases-9th Revision codes. Multivariate linear and logistic regressions were used to calculate odds ratios for primary and secondary outcomes while adjusting for confounders. Results: Of the 5,093 patients who underwent TMVr procedure, 464 (9.1%) were obese. Those with obesity were younger (median age 70 vs. 78 years; p < 0.001), more likely to be female, and more likely to have diabetes with chronic complications, hypertension, and previous myocardial infarction (p < 0.05 for all). There was no significant difference in all-cause in-hospital mortality (adjusted odds ratio [aOR]: 0.81; 95% confidence interval [CI]: 0.38 to 1.73), in-hospital cardiac arrest (aOR: 0.43; 95% CI: 0.16 to 1.16), cardiogenic shock, post-operative myocardial infarction, iatrogenic cardiac complications, post-operative respiratory failure, and acute kidney injury requiring dialysis between the 2 groups (p > 0.05 for all). However, obese patients who underwent TMVr had higher odds of blood loss requiring transfusion (aOR: 1.34; 95% CI: 1.03 to 1.75), post-operative shock (aOR: 8.83; 95% CI: 4.19 to 18.63), perioperative stroke (aOR: 3.06; 95% CI: 1.20 to 7.82), and infection (aOR: 2.11; 95% CI: 1.15 to 3.87) as compared to nonobese patients (Tables 1A and 1B). [Figure presented] Conclusion: An obesity paradox was not demonstrated after TMVr. Obese patients are more prone to stroke, infections, and major bleeding compared with nonobese patients. Categories: STRUCTURAL: Valvular Disease: Mitral