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This study aimed to investigate the prognostic significance of underweight status in patients undergoing SAVR and to identify key determinants of adverse outcomes within this population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>805 patients underwent SAVR between January 2016 and December 2021 at eight Japanese centers. After excluding 31 patients with missing laboratory data, a total of 774 patients were included. Patients were categorized into underweight group (Body mass index [BMI]\u2009&lt;\u200918.5\u00a0kg\/m\u00b2, 79 patients), normal-weight group (BMI 18.5\u201325\u00a0kg\/m\u00b2, 464 patients), and overweight group (BMI\u3000\u226525\u00a0kg\/m\u00b2, 231 patients). The primary endpoint was all-cause mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The median age was 76 years (interquartile range [IQR]: 71\u201379), and the median BMI was 23.3\u00a0kg\/m\u00b2 (IQR: 20.9\u201325.8). Underweight patients had the highest 5-year mortality, followed by normal-weight and overweight patients (23.5%, 11.9%, and 7.4%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001). In multivariable analysis, BMI was an independent predictor of mortality (1.0\u00a0kg\/m\u00b2 increase, adjusted hazard ratio: 0.92; 95% confidence interval: 0.86 to 0.99;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.020). Among underweight patients, serum albumin was independently associated with all-cause mortality (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002). Underweight patients were stratified by median albumin into low (&lt;\u20094.0\u00a0g\/dL,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200943) and normal (\u2265\u20094.0\u00a0g\/dL,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200936) groups, and 5-year mortality was higher in the low albumin group (34.1% vs. 12.6%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.015).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Low BMI was associated with higher mortality after SAVR, and serum albumin provided additional risk stratification within underweight group.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11748-026-02299-3","type":"journal-article","created":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T07:45:54Z","timestamp":1777275954000},"page":"939-949","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prognostic utility of serum albumin in underweight patients who underwent isolated surgical aortic valve replacement"],"prefix":"10.1007","volume":"74","author":[{"given":"Takahiro","family":"Ohmori","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1102-111X","authenticated-orcid":false,"given":"Koichi","family":"Maeda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyongsun","family":"Pak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akinobu","family":"Ohtani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yusuke","family":"Yanagino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuma","family":"Handa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takura","family":"Taguchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koichi","family":"Inoue","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ai","family":"Kawamura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shigeru","family":"Miyagawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,27]]},"reference":[{"key":"2299_CR1","doi-asserted-by":"publisher","first-page":"635","DOI":"10.1016\/j.jacasi.2022.06.002","volume":"2","author":"K Maeda","year":"2022","unstructured":"Maeda K, Kumamaru H, Kohsaka S, Shimamura K, Mizote I, Yamashita K, et al. 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KM has received institutional research grants and support from Medtronic and Edwards Lifesciences. KM and KS serve as proctors for the SAPIEN and Evolut valve series.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}}]}}