van Straten Albert H M, Safari Mojyan, Ozdemir H Ibrahim, Elenbaas Ted W, Hamad Mohamed A Soliman
Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands.
J Heart Valve Dis. 2013 Sep;22(5):608-14.
Data relating to the impact of body mass index (BMI) on outcomes after isolated aortic valve replacement (AVR) are scarce and controversial. The study aim was to investigate the predictive value of BMI for early and late mortality after isolated AVR.
Data obtained from patients who underwent isolated AVR between January 1998 and December 2010 at the authors' institution were analyzed retrospectively. Patients were allocated to five groups according to the preoperative BMI: underweight (BMI < 20 kg/m2); normal weight (BMI 20.0-24.9 kg/m2); overweight (BMI 25.0-29.9 kg/m2); obese (BMI 30.0-34.9 kg/m2); and morbidly obese (BMI > 34.9 kg/m2). Logistic and Cox regression analyses were performed to identify the independent predictors of early and late mortality, respectively.
After excluding 20 patients who were lost to follow up, and 30 patients with missing preoperative BMI data, a total of 1,758 patients was included in the analysis. The mean follow up was 5.6 +/- 3.5 years (range: 0-13.4 years), and the mean BMI 26.8 +/- 4.3 kg/m2 (range: 17-52 kg/m2). Multivariate logistic regression analyses showed no association between early mortality and the BMI groups. Multivariate Cox regression analyses showed 'underweight' to be an independent predictor for late mortality (hazard ratio 2.89; 95% confidence interval 1.63-5.13, p < 0.0001).
'Underweight' is an independent predictor for late mortality after AVR surgery. Morbid obesity did not prove to be predictive of a worse late survival.
关于体重指数（BMI）对单纯主动脉瓣置换术（AVR）后结局影响的数据稀缺且存在争议。本研究旨在探讨BMI对单纯AVR术后早期和晚期死亡率的预测价值。
回顾性分析1998年1月至2010年12月在作者所在机构接受单纯AVR手术患者的数据。根据术前BMI将患者分为五组：体重过轻（BMI<20kg/m²）；正常体重（BMI 20.0 - 24.9kg/m²）；超重（BMI 25.0 - 29.9kg/m²）；肥胖（BMI 30.0 - 34.9kg/m²）；病态肥胖（BMI>34.×9kg/m²）。分别进行逻辑回归和Cox回归分析以确定早期和晚期死亡率的独立预测因素。
排除20例失访患者和30例术前BMI数据缺失患者后，共1758例患者纳入分析。平均随访时间为5.6±3.5年（范围：0 - 13.4年），平均BMI为26.8±4.3kg/m²（范围：17 - 52kg/m²）。多因素逻辑回归分析显示早期死亡率与BMI分组之间无关联。多因素Cox回归分析显示“体重过轻”是晚期死亡率的独立预测因素（风险比2.89；95%置信区间1.63 - 5.13，p<0.0001）。
“体重过轻”是AVR手术后晚期死亡率的独立预测因素。病态肥胖并未被证明可预测较差的晚期生存率。
