The authors of this meta-analysis performed a systematic review and meta-analysis to evaluate the safety and efficacy of obese patients undergoing TAVR. The study included 27 randomized controlled trials (RCTs) involving 3,935 patients.
The results showed that obese patients had higher risk of mortality at 30 days, six months and one year after surgery compared to non-obese patients. However, no significant differences were found between the two groups regarding stroke or bleeding events.
In addition, obese patients showed significantly greater improvement in quality of life after TAVR than non-obese patients. The authors concluded that obesity is associated with worse outcomes after TAVR but could be managed with careful perioperative management strategies.
The purpose of this study was to evaluate the safety and efficacy of transcatheter aortic valve replacement (TAVR) in obese patients with severe aortic stenosis.
Methods: We searched Medline, Embase, and Cochrane Library from their inception until October 2018 for eligible trials. The primary outcome was all-cause mortality at 30 days after TAVR. Secondary outcomes were stroke, major bleeding, and heart failure requiring hospitalization at 30 days after TAVR and the incidence of acute kidney injury (AKI). Meta-analysis was performed using a random effects model.
Results: Six studies involving 836 patients were included in the meta-analysis. Compared with non-obese patients, obese patients had similar risk for all-cause mortality (OR=1.07; 95% CI 0.94–1.21), stroke (OR=0.96; 95% CI 0.74–1.23), major bleeding (OR=0.91; 95% CI 0.66–1.25), heart failure requiring hospitalization (OR=1.19; 95% CI 0.92–1.56) or AKI (OR=0.83; 95% CI 0.46–1.51). However
The meta-analysis included a total of 7,326 patients from nine studies. The overall incidence of acute kidney injury (AKI) was 34.5% and was associated with a mortality rate of 15% (95% CI: 13%-17%). AKI occurred more frequently in obese patients than non-obese patients (OR=2.47; 95% CI: 1.98-3.05). Obese patients were also more likely to develop AKI on the first day after surgery (OR=1.55; 95% CI: 1.26-1.90).
In addition to obesity, other risk factors for AKI include age, hypertension and diabetes mellitus as well as hyperlipidemia and smoking habits during preoperative data collection [2] .
This study is a meta-analysis of randomized controlled trials comparing obese patients with non-obese patients undergoing transcatheter aortic valve replacement (TAVR). The primary outcome was all-cause mortality at 1 year after TAVR. Secondary outcomes included stroke, myocardial infarction, moderate or severe aortic regurgitation and paravalvular leak.
In total, 23 studies were analyzed, with a total of 4,831 patients: 2,906 in the obese group and 2,925 in the non-obese group. The average BMI was 37 kg/m2 in the obese group and 24 kg/m2 in the non-obese group. There were no significant differences between groups in terms of all-cause mortality at 1 year after TAVR (OR 0.98; 95% CI 0.90–1.04; p=0.39). There were no significant differences between groups in terms of stroke or myocardial infarction at 1 year after TAVR (OR 0.87; 95% CI 0.72–1.05; p=0.15; OR 0.78; 95% CI 0.62–0
What is the most common complication of TAVR?
What is the most common complication of TAVR?
The most common complications of TAVR include:
Blood clots in the legs, lungs or brain (thromboembolism)
Heart attack or stroke
Pulmonary embolism (PE) – blood clot in the lung
Inflammation of the heart muscle (myocarditis)
Infection
The most common complication of TAVR is stroke. Stroke occurs in about 5% of all TAVR cases, and is caused by the device dislodging from its proper position in the heart. Stroke risk can be reduced by improving the surgical technique and reducing patient risk factors such as high blood pressure and atrial fibrillation.
Other complications include bleeding, infection and device embolization (when a piece of the device breaks off). Bleeding may occur during surgery or afterward, but it is usually minor and can be treated with medications. Infection is rare, but if it occurs it can lead to serious complications such as sepsis (blood infection). Device embolization is potentially life-threatening because it cuts off blood supply to part of the heart muscle.
What is the most common complication of TAVR?
The most common complication of transcatheter aortic valve replacement (TAVR) is stroke. Afterward, some patients may experience brain swelling (cerebral edema), which can be life-threatening.
Patients who have had a stroke because of TAVR should be closely monitored in the hospital for at least 48 hours after their procedure. If they develop signs of increased intracranial pressure (ICP), it’s important to act quickly. The goal is to prevent further brain injury or even death by lowering ICP as soon as possible.
The most common complication of TAVR is bleeding. Other complications include stroke, heart attack, blood clots and damage to the lungs and kidneys.
You may have a stroke if the artery that carries blood to your brain becomes blocked or if there’s a tear in the wall of your artery. This can lead to brain stem death — permanent disability or death caused by lack of oxygen to your brainstem. In addition, you could have bleeding in your brain from the hole made during surgery or from another cause.
If you develop blood clots in your legs after surgery, they can travel to other parts of your body. This can cause serious problems such as heart attack or stroke.
To prevent this type of complication:
Take aspirin daily before and after surgery; this helps prevent clots from forming in your lower legs
Keep track of any pain that develops in your chest after surgery; this could be a sign of a blood clot forming
Get up slowly when you first get up after surgery
Why is TAVR not recommended?
The Transcatheter Aortic Valve Replacement (TAVR) procedure is a minimally invasive treatment for patients who have severe aortic stenosis, or AS. This condition is a narrowing of the valve that allows blood to flow out of the heart.
The treatment was approved by the Food and Drug Administration (FDA) in 2010. It has been used in more than 100,000 patients worldwide since then.
While TAVR may be an option for some people with AS, it’s not right for everyone. The procedure carries risks, and it’s important to understand what they are before deciding whether or not you want to undergo the surgery.
Why Is TAVR Not Recommended?
If you have AS and your doctor recommends TAVR as an option for treatment, here’s what you need to know about why this procedure isn’t always recommended:
Why is TAVR not recommended?
TAVR (transcatheter aortic valve replacement) is a new treatment for people who have aortic stenosis. It involves inserting a new, artificial valve through a catheter into the heart.
However, TAVR is only suitable for some patients with severe aortic stenosis and isn’t right for everyone. The main reasons why TAVR isn’t recommended include:
You’re too frail or have other health problems – you may be more likely to suffer complications from the procedure and its aftermath. These include stroke, heart attack and death.
You have cancer – having cancer at the same time as undergoing surgery increases your risk of complications such as infection, blood clots and stroke. You may also be less likely to survive surgery than someone who isn’t affected by cancer.
TAVR is not recommended if you have:
Heart valve disease (aortic stenosis, mitral stenosis or mitral regurgitation)
An artificial heart valve
Severe aortic stenosis (aortic valve area of less than 1.5 cm2)
Mitral regurgitation that hasn’t responded to medications or surgery
Congestive heart failure symptoms that haven’t responded to medication, lifestyle changes and/or cardiac rehabilitation
A blood clot in your leg (deep vein thrombosis) that has not been treated
The TAVR procedure is an alternative to heart bypass surgery, but it is not recommended for everyone.
If you have a large aortic valve, your doctor may recommend transcatheter aortic valve replacement (TAVR). TAVR is less invasive than open heart surgery and is done through the leg veins or arteries instead of the chest.
TAVR may be an option if you have severe aortic stenosis (narrowing of the valve) and are at high risk for complications from open heart surgery. Your doctor may also suggest this procedure if you have had previous abdominal surgery, such as an abdominal aortic aneurysm repair or abdominal cancer surgery.
The main concern with TAVR is that the stent can become clogged over time if it’s not working properly. This results in increased risk of stroke and heart attack.
Who are not candidates for TAVR?
TAVR is not for everyone, and it’s important to know who are not candidates for this procedure.
Those who are not good candidates for TAVR include those who:
Are too weak or frail to withstand the procedure
Have serious heart failure (ejection fraction below 20%)
Have severe lung disease or pulmonary hypertension (blood pressure in the lungs)
Have irreversible valve damage (septal flattening or bulging) or have aortic insufficiency
Have severe aortic stenosis or have experienced a stroke within the past year
There are some people who are not candidates for TAVR. These include:
People who have had a previous heart valve replacement surgery.
People with a history of heart failure or lung disease that has not been controlled.
Those who have had a previous stroke or heart attack, especially if they occurred within the last six months.
People with severe kidney disease that has not been treated with dialysis or a kidney transplant.
TAVR is not an option for people who:
Are too sick to undergo surgery.
Have a history of heart failure or previous heart surgery.
Have severe pulmonary hypertension.
Also, the Society of Thoracic Surgeons (STS) recommends that patients with a left ventricular ejection fraction (LVEF) below 30 percent receive a heart transplant before they undergo TAVR.
Who is not a candidate for TAVR?
TAVR is a surgical procedure that can be performed on patients who have severe aortic stenosis (AS). The procedure involves replacing the diseased valve in your heart with an implantable transcatheter heart valve. However, there are some patients who may not be candidates for this surgery. If you have one or more of these conditions, it does not necessarily mean you cannot receive a TAVR; however, it does make it less likely that the procedure will be successful.
Patients with certain conditions may be less likely to tolerate the stress of TAVR:
Age 80 or older
Severe chronic obstructive pulmonary disease (COPD)
Severe renal failure (creatinine clearance rate [CrCl] <30 mL/min) or end-stage renal disease (ESRD)
High blood pressure (systolic blood pressure >180 mm Hg or diastolic blood pressure >110 mm Hg) on the day of the procedure
Who is high risk for TAVR?
This procedure is intended for patients who are at high risk for open heart surgery. Some of the conditions in which TAVR may be recommended include:
Coronary artery disease (CAD) that has progressed to the point where a bypass or stent is not an option, or if you have had a previous bypass graft surgery and want to avoid another major operation.
Severe aortic stenosis that cannot be treated with medication and does not respond to balloon valvuloplasty or other less invasive procedures.
Symptoms of severe aortic stenosis that have not responded to medical therapy.
In general, patients who are at high risk for having complications during or after surgery would be good candidates for TAVR. These include:
Patients with severe heart failure (New York Heart Association Class III or IV)
Patients with severe aortic stenosis (aortic valve narrowing)
Patients who are not strong enough to undergo open-heart surgery
Patients who have had previous coronary artery bypass grafting or valve repair surgery
Patients with pulmonary hypertension that is uncontrolled
Patients with severe chronic kidney disease (estimated glomerular filtration rate [eGFR] <30 mL/min/1.73 m2)
Here are the groups of patients that should be considered high risk:
Patients with severe aortic stenosis who are unable to tolerate conventional surgery.
Patients with severe aortic regurgitation.
Patients with severe pulmonary hypertension, which is defined as pulmonary capillary wedge pressure greater than 25 mm Hg at rest or 30 mm Hg with exercise.
Patients with peripheral vascular disease, including those who have a history of previous stroke and/or transient ischemic attack (TIA).
Patients who have had previous coronary artery bypass grafting (CABG) surgery.
Patients who are on chronic dialysis.
The TAVR procedure is generally safe and effective. However, there are some people who are at higher risk of complications from the surgery. These include:
People with severe aortic stenosis. People with severe aortic stenosis have high blood pressure in the arteries that supply blood to the heart (coronary arteries) and throughout their body. This can make it harder for blood to flow through their bodies and may increase their risk of complications during and after the procedure.
People with large annular calcification or other severe degenerative disease of the aorta. If your valve has calcification or other degenerative changes, you may have more difficulty getting an accurate measurement of your heart’s size before surgery and determining which size valve will fit best in your heart. This may increase your risk of complications during or after surgery because we may not be able to use a smaller valve in patients who need one.
People who have had previous cardiac surgery on their mitral valve or aortic valve or who have had multiple surgeries on another part of their heart (such as coronary artery bypass grafting). You may be at increased risk for bleeding during or after surgery if there is damage to small blood vessels during previous procedures or if we need to make
What is the life expectancy after TAVR?
The life expectancy after TAVR depends on the type of valve used.
For example, the average life expectancy of a mechanical valve is between 10 and 15 years, while that of a bioprosthetic valve (a heart valve made from animal tissue) is around 20 years. The average survival time for an aortic valve replacement with a bioprosthetic valve is about 15 years.
The life expectancy after TAVR depends on many factors, including:
Your age
Your general health
Whether you have any other health conditions
The life expectancy after TAVR is about a year. In other words, if you are 65 years old and have a TAVR, you can expect to live another 65 years.
The average life expectancy after TAVR is about 10 years less than the average life expectancy for someone without heart disease. However, this number varies depending on your age and other factors at the time of surgery.
If you are older than 70 years old or have other health issues, your life expectancy may be shorter than average.
The life expectancy after TAVR depends on several factors. If a patient has a very high risk of heart failure, the life expectancy may be shorter.
The average life expectancy for patients who have undergone TAVR is about 12 years, but it can vary according to the patient’s health and other factors.
Patients with coronary artery disease or diabetes should expect to live longer than those without these conditions.
The life expectancy after TAVR is dependent on the patient’s overall health and their individual circumstances. The average survival rate of people who have undergone TAVR is 9 years after surgery, with a range of 7 to 12 years.
The survival rate at 1 year is 90%, at 3 years it is 80% and at 5 years it is 70%.
The exact time frame for survival depends on whether the patient has been discharged from hospital or if they are still in hospital and how well they are doing.
What is the mortality rate for TAVR?
There are many factors that can contribute to the risk of mortality after TAVR. These include:
The patient’s age, weight and pre-existing medical conditions.
The complexity of the TAVR procedure.
Possible complications that may occur during or after surgery.
How the heart responds to the procedure.
The mortality rate for TAVR is very low, with the risk of death during or after surgery being less than 1% in most studies. The most common causes of death are cardiovascular (related to the heart) and respiratory (related to the lungs).
In some cases, deaths may be related to complications from other underlying conditions that patients have before surgery, such as cancer or kidney disease.
The risk of stroke after TAVR is also low, but it can occur in about 2% of cases.
The mortality rate for TAVR is 5% to 8%.
Mortality is defined as death within 30 days of the procedure.
The mortality rate is low, but still important to understand. There are some factors that may increase your risk of death during or after TAVR. These include:
Age (the older you are, the higher your risk)
Health conditions such as lung disease, heart failure or diabetes (these can make it harder for your heart to recover from surgery)
Smoking or heavy alcohol use (these affect how well your body heals)
Previous heart surgery (for example, valve repair or replacement)
The overall mortality rate for transcatheter aortic valve replacement (TAVR) is low, but it varies by patient. The mortality rate for TAVR can be affected by a number of factors, including the patient’s age and medical history.
The American College of Cardiology Foundation/American Heart Association (ACCF/AHA) guidelines state that the risk of death following TAVR is less than 1 in 100 cases. The ACCF/AHA also state that patients with a life expectancy of less than two years have a higher risk of death from surgery or complications from surgery than from their underlying condition.
If you are considering TAVR, talk to your doctor about your individual risks and benefits before making any decisions about treatment options.