Key Laboratory of Cardio-Thoracic Surgery, Department of Cardiovascular Surgery and Cardiac Disease Center, Union Hospital, Fujian Medical University, Fujian Province University, Fuzhou, 350001, People's Republic of China.
J Cardiothorac Surg. 2022 Jun 13;17(1):156. doi: 10.1186/s13019-022-01910-x.
Transcatheter aortic valve implantation (TAVI) for symptomatic aortic stenosis is considered a minimally invasive procedure. Body mass index (BMI) has been rarely evaluated for pulmonary complications after TAVI. This study aimed to assess the influence of BMI on pulmonary complications and other related outcomes after TAVI.
The clinical data of 109 patients who underwent TAVI in our hospital from May 2018 to April 2021 were retrospectively analyzed. Patients were divided into three groups according to BMI: low weight (BMI < 21.9 kg/m, n = 27), middle weight (BMI 21.9-27.0 kg/m, n = 55), and high weight (BMI > 27.0 kg/m, n = 27); and two groups according to vascular access: through the femoral artery (TF-TAVI, n = 94) and through the transapical route (TA-TAVI, n = 15). Procedure endpoints, procedure success, and adverse outcomes were evaluated according to the Valve Academic Research Consortium (VARC)-2 definitions.
High-weight patients had a higher proportion of older (p < 0.001) and previous percutaneous coronary interventions (p = 0.026), a higher percentage of diabetes mellitus (p = 0.026) and frailty (p = 0.032), and lower glomerular filtration rate (p = 0.024). Procedure success was similar among the three groups. The 30-day all-cause mortality of patients with low-, middle-, and high weights was 3.7% (1/27), 5.5% (3/55), and 3.7% (1/27), respectively. In the multivariable analysis, middle- and high-weight patients exhibited similar overall mortality (middle weight vs. low weight, p = 0.500; high weight vs. low weight, p = 0.738) and similar intubation time compared with low-weight patients (9.1 ± 7.3 h vs. 8.9 ± 6.0 h vs. 8.7 ± 4.2 h in high-, middle-, and low-weight patients, respectively, p = 0.872). Although high-weight patients had a lower PaO/FiO ratio than low-weight patients at baseline, transitional extubation, and post extubation 12th hour (p = 0.038, 0.030, 0.043, respectively), there were no differences for post extubation 24th hour, post extubation 48th hour, and post extubation 72nd hour (p = 0.856, 0.896, 0.873, respectively). Chronic lung disease [odds ratio (OR) 8.038, p = 0.001] rather than high weight (OR 2.768, p = 0.235) or middle weight (OR 2.226, p = 0.157) affected postoperative PaO/FiO after TAVI.
We did not find the existence of an obesity paradox after TAVI. BMI had no effect on postoperative intubation time. Patients with a higher BMI should be treated similarly without the need to deliberately extend the intubation time for TAVI.
经导管主动脉瓣置换术（TAVI）治疗症状性主动脉狭窄被认为是一种微创手术。体重指数（BMI）很少用于评估 TAVI 后肺部并发症。本研究旨在评估 BMI 对 TAVI 后肺部并发症和其他相关结局的影响。
回顾性分析了我院 2018 年 5 月至 2021 年 4 月期间接受 TAVI 的 109 例患者的临床资料。患者根据 BMI 分为三组：低体重组（BMI<21.9kg/m2，n=27）、中体重组（BMI 21.9-27.0kg/m2，n=55）和高体重组（BMI>27.0kg/m2，n=27）；根据血管入路分为两组：经股动脉（TF-TAVI，n=94）和经心尖（TA-TAVI，n=15）。根据 Valve Academic Research Consortium（VARC）-2 定义评估手术终点、手术成功率和不良结局。
高体重患者中年龄较大的比例更高（p<0.001），且既往经皮冠状动脉介入治疗的比例更高（p=0.026），糖尿病（p=0.026）和虚弱（p=0.032）的比例更高，肾小球滤过率（p=0.024）更低。三组间手术成功率相似。低、中、高体重患者的 30 天全因死亡率分别为 3.7%（27 例中的 1 例）、5.5%（55 例中的 3 例）和 3.7%（27 例中的 1 例）。多变量分析显示，中、高体重患者的总死亡率与低体重患者相似（中体重与低体重比较，p=0.500；高体重与低体重比较，p=0.738），与低体重患者相比，插管时间相似（9.1±7.3h 比 8.9±6.0h 比 8.7±4.2h，p=0.872）。尽管高体重患者的 PaO/FiO 比值在基线、过渡性拔管和拔管后 12 小时时低于低体重患者（p=0.038、0.030、0.043），但在拔管后 24 小时、拔管后 48 小时和拔管后 72 小时时无差异（p=0.856、0.896、0.873）。慢性肺部疾病（比值比 8.038，p=0.001）而不是高体重（比值比 2.768，p=0.235）或中体重（比值比 2.226，p=0.157）影响 TAVI 后术后 PaO/FiO。
我们在 TAVI 后没有发现肥胖悖论的存在。BMI 对术后插管时间没有影响。BMI 较高的患者应接受类似的治疗，无需故意延长 TAVI 的插管时间。
