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Balkanay OO, Bulut HI, Albrahimi E, Mirizade M, Yenigün AO, Tomey D, Bistre J, Oviedo RJ, Tel Ustunisik C, Arapi B, Goksedef D, Omeroglu SN, Ipek G. Optimizing aortic valve prosthesis selection in patients with obesity: Institutional experience with multidisciplinary perspective. Asian Cardiovasc Thorac Ann 2023; 31:667-674. [PMID: 37609760 DOI: 10.1177/02184923231197022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
BACKGROUND Aortic valve diseases are life-threatening conditions with increasing prevalence worldwide. Risk factors include gender, age, hypertension, dyslipidemia, and type 2 diabetes. Obesity is closely related to these risk factors and has been linked to a higher risk of developing aortic valve diseases. However, there is no specific guideline for managing aortic valve disease in patients with obesity, and the choice of valve type remains uncertain. METHODS A total of 130 patients with obesity who met the inclusion criteria underwent surgical aortic valve replacement. The patients were divided into two groups based on the type of prosthesis used. Among the study cohort, 50 patients received a bioprosthetic valve, while 80 patients received a mechanical valve. We compared these groups in terms of perioperative characteristics and follow-up results. Statistical significance was determined using a p-value threshold of 0.05. RESULTS There were no significant differences in age, gender, body mass index, or cardiac comorbidities between the two groups. Preoperative blood results and echo findings also showed no significant differences. Intraoperative characteristics and postoperative outcomes, including mortality and acute kidney injury, did not differ significantly between the groups. In addition, BHVG patients had shorter ICU stays compared to MHVG patients without significance. CONCLUSION Deliberate consideration is crucial when selecting valves for obese patients, particularly those with class II obesity. This is due to the potential influence of obesity on valve types, as well as the need to account for the possibility of bariatric surgery and its potential effects.
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Affiliation(s)
- Ozan Onur Balkanay
- Department of Cardiovascular Surgery Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Halil Ibrahim Bulut
- Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ergida Albrahimi
- Department of Cardiovascular Surgery Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Miri Mirizade
- Department of Cardiovascular Surgery Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Abdulgani Orhun Yenigün
- Department of Cardiovascular Surgery Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Daniel Tomey
- Department of General Surgery, Houston Methodist Hospital, Houston, TX, USA
- Houston Methodist, Institute for Technology, Innovation & Education, Houston, TX, USA
| | | | - Rodolfo J Oviedo
- Dorrington Medical Associates, Houston, TX, USA
- Weill Cornell Medical College, General Surgery, New York, NY, USA
- Texas A&M University College of Medicine, General Surgery, Bryan, TX, USA
| | - Cigdem Tel Ustunisik
- Department of Cardiovascular Surgery Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Berk Arapi
- Department of Cardiovascular Surgery Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Deniz Goksedef
- Department of Cardiovascular Surgery Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Suat Nail Omeroglu
- Department of Cardiovascular Surgery Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Gokhan Ipek
- Department of Cardiovascular Surgery Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Saeed Al-Asad K, Martinez Salazar A, Yavari M, Panama G, Sabanci R, Saeed M, Abela G. In-Hospital Outcomes of Transcatheter Aortic Valve Replacement Versus Surgical Aortic Valve Replacement in Obesity. Am J Cardiol 2023; 201:391-393. [PMID: 37438228 DOI: 10.1016/j.amjcard.2023.06.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/14/2023] [Accepted: 06/24/2023] [Indexed: 07/14/2023]
Affiliation(s)
- Khalid Saeed Al-Asad
- Departments of Internal Medicine, Michigan State University, East Lansing, Michigan.
| | | | - Majid Yavari
- Departments of Internal Medicine, Michigan State University, East Lansing, Michigan
| | - Gabriel Panama
- Departments of Internal Medicine, Michigan State University, East Lansing, Michigan
| | - Rand Sabanci
- Departments of Internal Medicine, Michigan State University, East Lansing, Michigan
| | - Moiz Saeed
- Departments of Internal Medicine, Michigan State University, East Lansing, Michigan
| | - George Abela
- Departments of Cardiology, Michigan State University, East Lansing, Michigan
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Abi-Jaoude JG, Naiem AA, Edwards T, Lukaszewski MA, Obrand DI, Steinmetz OK, Bayne JP, MacKenzie KS, Gill HL, Girsowicz E. A systematic review and meta-analysis of the effect of obesity on patients undergoing lower extremity revascularization. J Vasc Surg 2022:S0741-5214(22)02637-4. [PMID: 36565774 DOI: 10.1016/j.jvs.2022.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 11/20/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE In the present review, we assessed the effect of obesity on clinical outcomes for patients with peripheral arterial disease who had undergone endovascular or open lower extremity revascularization surgery. METHODS A systematic search strategy of MEDLINE, EMBASE, CINAHL, Web of Science, and Cochrane Library was conducted. The included studies had compared obese and nonobese cohorts with peripheral arterial disease who had undergone endovascular or open lower extremity revascularization. The outcomes included mortality, major adverse cardiovascular events, major adverse limb events, surgical site infections, endovascular access site complications, and perioperative complications. RESULTS Eight studies were included with 171,648 patients. The obese patients (body mass index ≥30 kg/m2) were more likely to be women, to have diabetes, and to have more cardiovascular comorbidities despite being younger. No association was found between obesity and peripheral arterial disease severity. Obesity was associated with an overall 22% decreased mortality risk after lower extremity revascularization (risk ratio [RR], 0.78; 95% confidence interval [CI], 0.71-0.85; P < .001; I2 = 0%; GRADE (grading of recommendations assessment, development, evaluation), very low quality). A subgroup analysis by intervention type showed similar findings (endovascular: RR, 0.79; 95% CI, 0.71-0.87; P < .001; I2 = 0%; open: RR, 0.70; 95% CI, 0.51-0.95; P = .024; I2 = 43%). Obesity was associated with a 14% decreased risk of major adverse cardiovascular events for open surgery only (RR, 0.86; 95% CI, 0.76-0.98; P = .021; I2 = 0%; GRADE, very low quality). Obesity was associated with an increased risk of surgical site infections pooled across intervention types (RR, 1.69; 95% CI, 1.34-2.14; P < .001; I2 = 78%; GRADE, very low quality). No association was found between obesity and major adverse limb events (RR, 1.02; 95% CI, 0.93-1.11; P = .73; I2 = 15%; GRADE, very low quality) or endovascular access site complications (RR, 1.11; 95% CI, 0.76-1.63; P = .58; I2 = 86%; GRADE, very low quality). Pooled perioperative complications did not differ between the obese and nonobese cohorts (RR, 1.04; 95% CI, 0.84-1.28; P = .73; I2 = 92%; GRADE, very low quality). CONCLUSIONS Obesity was associated with reduced mortality risk with both endovascular and open surgery, although a reduction in major adverse cardiovascular events was only observed with open surgery. In addition, obese patients had an increased risk of surgical site infections. Obesity was not associated with major adverse limb events, endovascular access site complications, or perioperative complications. The GRADE quality of evidence was very low. The findings from the present review suggest a survival advantage for obese patients with peripheral arterial disease. Future studies could focus on prospectively investigating the effect of obesity on peripheral arterial disease outcomes. A nuanced evaluation of body mass index as a preoperative risk factor is warranted.
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Affiliation(s)
- Joanne G Abi-Jaoude
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Ahmed A Naiem
- Division of Vascular Surgery, McGill University, Montreal, QC, Canada
| | - Thomas Edwards
- Northern Ontario School of Medicine, Sudbury, ON, Canada
| | | | - Daniel I Obrand
- Division of Vascular Surgery, McGill University, Montreal, QC, Canada
| | - Oren K Steinmetz
- Division of Vascular Surgery, McGill University, Montreal, QC, Canada
| | - Jason P Bayne
- Division of Vascular Surgery, McGill University, Montreal, QC, Canada
| | - Kent S MacKenzie
- Division of Vascular Surgery, McGill University, Montreal, QC, Canada
| | - Heather L Gill
- Division of Vascular Surgery, McGill University, Montreal, QC, Canada
| | - Elie Girsowicz
- Division of Vascular Surgery, McGill University, Montreal, QC, Canada.
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Alnajar A, Hamad N, Azhar MZ, Mousa Y, Arora Y, Lamelas J. Surgical versus transcatheter aortic valve replacement: Impact of patient-prosthesis mismatch on outcomes. J Card Surg 2022; 37:5388-5394. [PMID: 36378858 DOI: 10.1111/jocs.17217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 10/29/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND The hemodynamics of most prosthetic valves are often inferior to that of the normal native valve, and a significant proportion of patients undergoing surgical (SAVR) or transcatheter aortic valve replacement (TAVR) have high residual transaortic pressure gradients due to prosthesis-patient mismatch (PPM). As the experience with TAVR has increased and long-term outcomes are reported, a close look at the PPM literature is required in light of new evidence. METHODS For this review, we searched the Embase, Medline, and Cochrane databases from 2000 to 2022. Articles reporting PPM as an outcome following aortic valve replacements were identified and reviewed. RESULTS The impact of PPM on clinical outcomes in aortic valve replacement has not been clear as multiple studies failed to report PPM incidence. However, the PPM outcomes after SAVR vary more widely than after TAVR, ranging from 8% to 80% in SAVR and from 24% to 35% in TAVR. Incidence of severe PPM following redo SAVR ranges from 2% to 9% and following valve-in-valve TAVR is from 14% to 33%, however, while PPM is higher in valve-in-valve TAVR, patients had better survival rates. CONCLUSIONS The gap between valve performance and clinical outcomes in SAVR and TAVR could be reduced by carefully selecting patients for either treatment option. Understanding predictors of PPM can add to the safety, effectiveness, and increased survival benefit of both SAVR and TAVR.
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Affiliation(s)
- Ahmed Alnajar
- Department of Surgery, Division of Cardiothoracic Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Naser Hamad
- Department of Surgery, Division of Cardiothoracic Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | | | - Yaseen Mousa
- Florida Atlantic University, Boca Raton, Florida, USA
| | - Yingyot Arora
- Department of Surgery, Division of Cardiothoracic Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Joseph Lamelas
- Department of Surgery, Division of Cardiothoracic Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
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Djouani A, Smith A, Choi J, Lall K, Ambekar S. Cardiac surgery in the morbidly obese. J Card Surg 2022; 37:2060-2071. [PMID: 35470870 DOI: 10.1111/jocs.16537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/28/2022] [Accepted: 04/01/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Obesity rates globally continue to rise and in turn the body mass index (BMI) of patients undergoing cardiac surgery is set to mirror this. Patients who are Class III obese (BMI ≥ 40) pose significant challenges to the surgical teams responsible for their care and are also at high risk of complications from surgery and even death. To improve outcomes in this population, interventions carried out in the preoperative, operative, and postoperative periods have shown promise. Despite this, there are no defined best practice national guidelines for perioperative management of obese patients undergoing cardiac surgery. AIM This review is aimed at clinicians and researchers in the field of cardiac surgery and aims to form a basis for the future development of clinical guidelines for the management of obese cardiac surgery patients. METHODS The PubMed database was utilized to identify relevant literature and strategies employed at various stages of the surgical journey were analyzed. CONCLUSIONS Data presented identified the benefits of preoperative respiratory muscle training, off-pump coronary artery bypass grafting where possible, and early extubation. Further randomized controlled trials are required to identify optimal operative and perioperative management strategies before the introduction of such guidance into clinical practice.
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Affiliation(s)
- Adam Djouani
- The Department of Cardiac Surgery, St Bartholomew's Hospital, London, UK
| | - Alexander Smith
- The Department of Cardiac Surgery, St Bartholomew's Hospital, London, UK
| | - Jeesoo Choi
- The Department of Cardiac Surgery, St Bartholomew's Hospital, London, UK
| | - Kulvinder Lall
- The Department of Cardiac Surgery, St Bartholomew's Hospital, London, UK
| | - Shirish Ambekar
- The Department of Cardiac Surgery, St Bartholomew's Hospital, London, UK
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Corcione N, Testa A, Ferraro P, Morello A, Cimmino M, Albanese M, Giordano S, Bedogni F, Iadanza A, Berti S, Regazzoli D, Trani C, Pepe M, Frati G, Biondi Zoccai G, Giordano A. Baseline, procedural and outcome features of patients undergoing transcatheter aortic valve implantation according to different body mass index categories. Minerva Med 2021; 112:474-482. [PMID: 33576201 DOI: 10.23736/s0026-4806.21.07379-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) has become first-line treatment for severe aortic valve stenosis in patients with moderate, high or prohibitive surgical risk. However, access site complications may occur more frequently in extreme body mass index (BMI) categories. The aim of this study was to describe the features and outcomes of patients undergoing TAVI in a comprehensive Italian prospective clinical registry, focusing on BMI classes. METHODS A national prospective database was queried for baseline, procedural, and outcome details of patients undergoing TAVI according to established BMI categories: underweight (BMI <18.5 kg/m2), normal weight (BMI 18.5-24.9 kg/m2), overweight (BMI 25.0-29.9 kg/m2), and obese (BMI≥30 kg/m2). Short- and long-term outcomes, including major adverse events (MAE), i.e. the composite of death, stroke, myocardial infarction, major vascular complication, major bleeding, or renal failure, were appraised with bivariate and multivariable analyses. RESULTS A total of 3075 subjects were included, 64 (2.1%) were underweight, 1319 (42.9%) were normal weight, 1152 (37.4%) were overweight, and 540 (17.6%) were obese. Several baseline differences were evident, including gender, diabetes mellitus, renal function, chronic obstructive pulmonary disease, surgical scores, and left ventricular ejection fraction (LVEF) (all P<0.05). Several procedural differences were also evident, including percutaneous approach, predilation, prosthesis type and size (all P<0.05), with postprocedural aortic regurgitation >2+ significantly more common in underweight patients (P<0.05). Nonetheless, unadjusted analysis for one-month outcomes showed similar rates for fatal and non-fatal outcomes, including MAE (all P>0.05), with the notable exception of permanent pacemaker implantation, which was more common in higher BMI classes (P=0.010) Unadjusted analysis for long-term events showed an increased rate of death in underweight patients (P=0.024). Multivariable adjusted analysis confirmed the increased risk of permanent pacemaker implantation in obese patients (P=0.015 when comparing obese vs. normal weight subjects), but disproved differences in long-term mortality and other outcomes (P>0.05 for all comparisons). CONCLUSIONS Irrespective of BMI class, TAVI is associated with favorable outcomes in surgical high-risk risk patients, with the notable exclusion of permanent pacemaker implantation, which is significantly more common in obese subjects.
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Affiliation(s)
- Nicola Corcione
- Unit of Cardiovascular Intervention, Pineta Grande Hospital, Castel Volturno, Caserta, Italy
| | | | - Paolo Ferraro
- Unit of Hemodynamics, Santa Lucia Hospital, San Giuseppe Vesuviano, Naples, Italy
| | - Alberto Morello
- Unit of Cardiovascular Intervention, Pineta Grande Hospital, Castel Volturno, Caserta, Italy
| | - Michele Cimmino
- Unit of Cardiovascular Intervention, Pineta Grande Hospital, Castel Volturno, Caserta, Italy
| | - Michele Albanese
- Unit of Hemodynamics, Santa Lucia Hospital, San Giuseppe Vesuviano, Naples, Italy
| | - Salvatore Giordano
- Unit of Cardiovascular Intervention, Pineta Grande Hospital, Castel Volturno, Caserta, Italy
| | - Francesco Bedogni
- Department of Cardiology, IRCCS San Donato Hospital, San Donato Milanese, Milan, Italy
| | - Alessandro Iadanza
- Division of Hemodynamics, Department of Cardiac, Thoracic and Vascular Sciences, Santa Maria alle Scotte Polyclinic, Siena, Italy
| | - Sergio Berti
- C.N.R. G. Monasterio Ospedale del Cuore Foundation, Massa, Massa Carrara, Italy
| | | | - Carlo Trani
- Institute of Cardiology, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Martino Pepe
- Division of Cardiology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Giacomo Frati
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy.,IRCCS NEUROMED, Pozzilli, Isernia, Italy
| | - Giuseppe Biondi Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy - .,Mediterranea Cardiocentro, Naples, Italy
| | - Arturo Giordano
- Unit of Cardiovascular Intervention, Pineta Grande Hospital, Castel Volturno, Caserta, Italy
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