TY - JOUR
T1 - Impact of Body Mass Index on Short- and Long-Term Outcomes After Isolated First-Time Surgical Aortic Valve Replacement for Aortic Stenosis
AU - Bruno, Vito Domenico
AU - Chivasso, Pierpaolo
AU - Rapetto, Filippo
AU - Guida, Gustavo
AU - Di Tommaso, Ettorino
AU - Chau, Hoi Man
AU - Vohra, Hunaid
PY - 2019/11/1
Y1 - 2019/11/1
N2 - Objective: To ascertain whether body mass index (BMI) has a clinical effect on short- and long-term postoperative outcomes after surgical aortic valve replacement in patients with severe aortic stenosis. Design: Single-center, retrospective study. Setting: Tertiary referral hospital. Participants: The study comprised 1,561 patients who underwent isolated first-time aortic valve replacement between 2005 and 2012. Interventions: Fourteen underweight patients were removed from the analysis. The remaining patients were divided into the following 4 groups according to their BMI: 418 as normal weight (≥18.5 to <25 kg/m
2 ), 629 as overweight (≥25 to <30 kg/m
2 ), 342 as obese (≥30 to <35 kg/m
2 ), and 158 as very obese (≥35 kg/m
2 ). Early mortality and postoperative complications were compared, and long-term survival rates were investigated. Measurement and Main Results: Thirty-day mortality was higher in the normal weight group but did not reach statistical significance (p = 0.054), and the incidence of postoperative complications was not different for cerebrovascular accident (p = 0.70), re-sternotomy for bleeding (p = 0.17), sternal wound infection (p = 0.07), and dialysis (p = 0.07). With a mean follow-up time of 4.92 ± 2.82years, survival rate was better in the overweight group. A Cox proportional hazard model found BMI inversely correlated with long-term mortality when analyzed in a univariable fashion (hazard ratio 0.95; p = 0.009), but this apparent protective effect disappeared when adjusted for preoperative covariates (hazard ratio 0.98, 95% confidence interval 0.96-1.004; p = 0.12). Conclusion: Once adjusted for preoperative characteristics, obesity does not represent an independent predictor for long-term survival rates. There was a higher incidence of 30-day mortality in the normal weight group compared with the overweight and very obese groups. The incidence of deep sternal wound infection was higher in very obese patients.
AB - Objective: To ascertain whether body mass index (BMI) has a clinical effect on short- and long-term postoperative outcomes after surgical aortic valve replacement in patients with severe aortic stenosis. Design: Single-center, retrospective study. Setting: Tertiary referral hospital. Participants: The study comprised 1,561 patients who underwent isolated first-time aortic valve replacement between 2005 and 2012. Interventions: Fourteen underweight patients were removed from the analysis. The remaining patients were divided into the following 4 groups according to their BMI: 418 as normal weight (≥18.5 to <25 kg/m
2 ), 629 as overweight (≥25 to <30 kg/m
2 ), 342 as obese (≥30 to <35 kg/m
2 ), and 158 as very obese (≥35 kg/m
2 ). Early mortality and postoperative complications were compared, and long-term survival rates were investigated. Measurement and Main Results: Thirty-day mortality was higher in the normal weight group but did not reach statistical significance (p = 0.054), and the incidence of postoperative complications was not different for cerebrovascular accident (p = 0.70), re-sternotomy for bleeding (p = 0.17), sternal wound infection (p = 0.07), and dialysis (p = 0.07). With a mean follow-up time of 4.92 ± 2.82years, survival rate was better in the overweight group. A Cox proportional hazard model found BMI inversely correlated with long-term mortality when analyzed in a univariable fashion (hazard ratio 0.95; p = 0.009), but this apparent protective effect disappeared when adjusted for preoperative covariates (hazard ratio 0.98, 95% confidence interval 0.96-1.004; p = 0.12). Conclusion: Once adjusted for preoperative characteristics, obesity does not represent an independent predictor for long-term survival rates. There was a higher incidence of 30-day mortality in the normal weight group compared with the overweight and very obese groups. The incidence of deep sternal wound infection was higher in very obese patients.
KW - aortic valve
KW - body mass index
KW - obesity
KW - outcomes
UR - http://www.scopus.com/inward/record.url?scp=85062983527&partnerID=8YFLogxK
U2 - 10.1053/j.jvca.2019.02.015
DO - 10.1053/j.jvca.2019.02.015
M3 - Article (Academic Journal)
C2 - 30898426
SN - 1053-0770
VL - 33
SP - 2995
EP - 3000
JO - Journal of Cardiothoracic and Vascular Anesthesia
JF - Journal of Cardiothoracic and Vascular Anesthesia
IS - 11
ER -