{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T06:06:21Z","timestamp":1785305181631,"version":"3.55.0"},"reference-count":61,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2021,12,28]],"date-time":"2021-12-28T00:00:00Z","timestamp":1640649600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Obesity"],"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:title>Summary<\/jats:title><jats:p>Obesity has been associated with increased incidence of comorbidities and shorter life expectancy, and it has generally been assumed that patients with obesity should have inferior outcomes after surgery. Previous literature has often demonstrated equivalent or even improved rates of mortality after cardiac surgery when compared to their lower\u2010weight counterparts, coined the obesity paradox. Herein, we aim to review the literature investigating the impact of obesity on surgical valve interventions. PubMed and Embase were systematically searched for articles published from 1 January 2000 to 15 October 2021. A total of 1315 articles comparing differences in outcomes between patients of varying body mass index (BMI) undergoing valve interventions were reviewed and 25 were included in this study. Patients with higher BMI demonstrated equivalent or reduced rates of postoperative myocardial infarction, stroke, reoperation rates, acute kidney injury, dialysis and bleeding. Two studies identified increased rates of deep sternal wound infection in patients with higher BMI, although the majority of studies found no significant difference in deep sternal wound infection rates. The obesity paradox has described counterintuitive outcomes predominantly in coronary artery bypass grafting and transcatheter aortic valve replacement. Recent literature has identified similar trends in other heart valve interventions. While the obesity paradox has been well characterized, its causes are yet to be identified. Further study is essential in order to identify the causes of the obesity paradox so patients of all body sizes can receive optimal care.<\/jats:p>","DOI":"10.1111\/cob.12506","type":"journal-article","created":{"date-parts":[[2021,12,28]],"date-time":"2021-12-28T10:42:48Z","timestamp":1640688168000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Heart valve surgery and the obesity paradox: A systematic review"],"prefix":"10.1111","volume":"12","author":[{"given":"Ryaan","family":"EL\u2010Andari","sequence":"first","affiliation":[{"name":"Faculty of Medicine and Dentistry University of Alberta  Edmonton Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabin J.","family":"Bozso","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Department of Surgery University of Alberta  Edmonton Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jimmy J. H.","family":"Kang","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Department of Surgery University of Alberta  Edmonton Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandre M. A.","family":"Bedard","sequence":"additional","affiliation":[{"name":"Department of Biological Sciences, Faculty of Science University of Alberta  Edmonton Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corey","family":"Adams","sequence":"additional","affiliation":[{"name":"Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta University of Calgary  Calgary Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Wang","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Department of Surgery University of Alberta  Edmonton Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2050-6717","authenticated-orcid":false,"given":"Jeevan","family":"Nagendran","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Department of Surgery University of Alberta  Edmonton Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,12,28]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12471-017-1003-2"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.transproceed.2016.12.002"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.metabol.2018.09.005"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCRESAHA.115.306883"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2019.10.193"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/MED.0000000000000471"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.2147\/VHRM.S168946"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2019.10.050"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.11622\/smedj.2020169"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpcardiol.2017.04.004"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1093\/icvts\/ivx383"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(06)69208-8"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjca.2014.03.022"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.116.022840"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.jvca.2019.02.015"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12872-020-01528-8"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/imi.0b013e3182a20e5a"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1038\/ijo.2016.20"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.116.003831"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00392-016-1027-4"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.26394"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2016.12.051"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.27547"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000020717"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2012.09.022"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.26377"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1002\/clc.22355"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1093\/icvts\/ivx191"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2018.11.015"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2020.09.039"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2016.09.031"},{"key":"e_1_2_10_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2013.08.022"},{"key":"e_1_2_10_34_1","first-page":"e5142","article-title":"Association between body mass index and permanent pacemaker implantation after transcatheter aortic valve replacement (TAVR) with Edwards SAPIEN\u2122 3 TAVR valves: a single\u2010center experience","volume":"11","author":"Ahmad M","year":"2019","journal-title":"Cureus"},{"key":"e_1_2_10_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocp.2019.09.027"},{"key":"e_1_2_10_36_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.b2535"},{"key":"e_1_2_10_37_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.b2700"},{"key":"e_1_2_10_38_1","doi-asserted-by":"publisher","DOI":"10.2522\/ptj.20070147"},{"key":"e_1_2_10_39_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.i4919"},{"key":"e_1_2_10_40_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2010.07.017"},{"key":"e_1_2_10_41_1","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezaa274"},{"key":"e_1_2_10_42_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.carrev.2021.08.011"},{"key":"e_1_2_10_43_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2019.10.193"},{"key":"e_1_2_10_44_1","doi-asserted-by":"crossref","first-page":"579","DOI":"10.2459\/JCM.0000000000001178","article-title":"BMI and acute kidney injury post transcatheter aortic valve replacement: unveiling the obesity paradox","volume":"22","author":"De Marzo V","year":"2021","journal-title":"J Cardiovasc Med"},{"key":"e_1_2_10_45_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41366-021-00933-z"},{"key":"e_1_2_10_46_1","first-page":"336","article-title":"Body mass index: a risk factor for 30\u2010day or six\u2010month mortality in patients undergoing aortic valve replacement?","volume":"15","author":"Florath I","year":"2006","journal-title":"J Heart Valve Dis"},{"key":"e_1_2_10_47_1","doi-asserted-by":"publisher","DOI":"10.1177\/0310057X1304100502"},{"key":"e_1_2_10_48_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2019.12.022"},{"key":"e_1_2_10_49_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.numecd.2020.04.009"},{"key":"e_1_2_10_50_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2020.09.001"},{"key":"e_1_2_10_51_1","doi-asserted-by":"publisher","DOI":"10.1155\/2020\/9732943"},{"key":"e_1_2_10_52_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2011.09.010"},{"key":"e_1_2_10_53_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2011.11.027"},{"key":"e_1_2_10_54_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2011.02.009"},{"key":"e_1_2_10_55_1","doi-asserted-by":"publisher","DOI":"10.5603\/KP.a2018.0243"},{"key":"e_1_2_10_56_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2012.07.041"},{"key":"e_1_2_10_57_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ccc.2010.06.004"},{"key":"e_1_2_10_58_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pcad.2018.07.003"},{"key":"e_1_2_10_59_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocp.2016.11.001"},{"key":"e_1_2_10_60_1","doi-asserted-by":"publisher","DOI":"10.1093\/cvr\/cvx106"},{"key":"e_1_2_10_61_1","doi-asserted-by":"publisher","DOI":"10.1097\/HCO.0000000000000764"},{"key":"e_1_2_10_62_1","doi-asserted-by":"publisher","DOI":"10.1097\/HCO.0000000000000803"}],"container-title":["Clinical Obesity"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/cob.12506","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/cob.12506","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/cob.12506","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,27]],"date-time":"2023-08-27T10:27:34Z","timestamp":1693132054000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/cob.12506"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12,28]]},"references-count":61,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2022,4]]}},"alternative-id":["10.1111\/cob.12506"],"URL":"https:\/\/doi.org\/10.1111\/cob.12506","archive":["Portico"],"relation":{},"ISSN":["1758-8103","1758-8111"],"issn-type":[{"value":"1758-8103","type":"print"},{"value":"1758-8111","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12,28]]},"assertion":[{"value":"2021-07-21","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-12-11","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-12-28","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e12506"}}