Outcomes of Surgical Versus Transcatheter Aortic Valve Replacement in Obese Patients: A Systematic Review and Meta-Analysis

Abstract

Transcatheter aortic valve implantation (TAVI) has been increasingly preferred over surgical aortic valve replacement (SAVR) for treating patients with severe aortic stenosis and intermediate to high surgical risk. Recent studies have indicated that obesity may confer protective benefits in cardiac surgery, known as the obesity paradox. We conducted a systematic review and meta-analysis to explore how obesity influences outcomes of TAVI versus SAVR. We searched and reviewed relevant studies comparing TAVI and SAVR in obese patients with aortic stenosis indexed in PubMed, Embase, and Scopus databases. Data from 5 studies with 16,161 patients (TAVI, n = 2951; SAVR, n = 13,210) were included. There was a lower incidence of postprocedural in-hospital mortality [risk ratio (RR), 0.64; 95% confidence interval (CI), 0.41-0.98; P = 0.04], acute kidney injury (RR, 0.53; 95% CI, 0.38-0.73; P = 0.0001), and shorter duration of in-hospital stay (mean difference: -3.35; 95% CI, -4.93 to -1.76; P = 0.0001) in TAVI versus SAVR. There was no significant difference in the risk of postoperative stroke (RR, 0.93; 95% CI, 0.29-3.02; P = 0.91), major bleeding (RR, 0.71; 95% CI, 0.47-1.07; P = 0.10), and myocardial infarction (RR, 0.64; 95% CI, 0.39-1.06; P = 0.08) between TAVI and SAVR. Higher incidences of PPM implantation (RR, 2.0; 95% CI, 1.38-2.90; P = 0.0003) and major vascular complications (RR, 1.51; 95% CI, 1.01-2.27; P = 0.05) were observed with TAVI. In obese patients, TAVI offers similar results as in the general population when compared with SAVR, except for increased vascular complications. An individualized approach can lead to optimal outcomes in this subpopulation.