Impact of obesity on outcomes of transcatheter aortic valve implantation in patients with aortic stenosis: a systematic review and meta-analysis of real-world data.

Most recent large-scale global analyses on transcatheter aortic valve implantation (TAVI) for aortic stenosis (AS) showed favorable survival outcomes in patients with high body mass index (BMI). We performed a meta-analysis pooling all clinical studies to assess the validity of improved post-TAVI prognosis in obese patients. MEDLINE and Scopus were queried till January 2023 to identify studies comparing AS patients with BMI≥30 kg/m², and BMI 18.5 to <25 undergoing TAVI. Data were analyzed using a random-effects model to derive odds ratios (ORs) for all outcomes, and hazard ratios (HRs) for long-term overall survival with 95% confidence intervals. The primary outcomes of interest included 30-day all-cause mortality and long-term overall survival while secondary outcomes consisted of myocardial infarction (MI), major bleeding, major vascular events and acute kidney injury (AKI). A total of 24 studies comprising 38,743 patients were included in this meta-analysis. All-cause mortality at 30-days was significantly reduced in patients with BMI>30 kg/m² (OR 0.71, P<0.0001) vs. normal BMI. Every 1 kg/m² increase in BMI was associated with better overall survival (HR 0.96, P<0.0001). Obese patients had greater long-term overall survival (HR 0.87, P<0.00001) compared with non-obese patients. No significant differences in MI (OR 0.84, 95% CI 0.52-1.34), major bleeding (OR 0.94, 95% CI 0.72-1.21), major vascular events (OR 1.18, 95% CI 0.97-1.43) and AKI (OR 1.17, 95% CI 0.87-1.56) were observed between the two groups. Obese AS patients might have similar procedural complications, but reduced mortality, and increased overall survival in comparison with normal weight individuals.