RECENT research suggests that transcatheter aortic valve replacement (TAVR) may be a more favourable option than surgery for patients with obesity and severe aortic stenosis, according to a meta-analysis conducted by Khalid Saeed Al-Asad, Michigan State University, East Lansing, USA, and colleagues.
Al-Sad and colleagues conducted a meta-analysis which included data from three registry based studies and one retrospective multi-centre study, involving 37,743 patients with obesity and severe aortic stenosis. The researchers observed that TAVR demonstrated better outcomes in terms of in-hospital mortality and other relevant measures compared to surgical aortic valve replacement. Notably, the primary outcome of in-hospital mortality was lower in the TAVR group.
The analysis yielded findings which were consistent with previous studies comparing TAVR with surgical aortic valve replacement. It was revealed that patients who underwent TAVR were less likely to have acute kidney injury, postoperative sepsis, and blood transfusion than those who underwent surgery. However, the findings demonstrated that the TAVR group was associated with a higher likelihood of requiring a permanent pacemaker implantation.
Although the analysis provides evidence that supports the feasibility and safety of TAVR in patients with obesity and severe aortic stenosis, the authors stressed the limited existing evidence and ongoing debate surrounding the optimal therapeutic approach for this patient population.
Caution is necessary when considering the best intervention for patients with obesity with severe aortic stenosis, and alternative access approaches, such as transradial, transcaval, transapical, or transcarotid, may be worth considering alongside the traditional transfemoral approach used for TAVR.
The researchers advocated for more research; in particular, randomised trials with long-term follow-up analyses of different obesity categories are needed to further investigate the efficacy and safety of TAVR in patients with obesity. Altogether, the meta-analysis provides valuable insights to guide clinical decision-making, potentially leading to improved patient outcomes for this subset of patients.