{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T19:40:51Z","timestamp":1792698051258,"version":"4.5.0"},"reference-count":43,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"12","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2021,6,15]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">There is a paucity of outcome data on patients who are morbidly obese (MO) undergoing transcatheter aortic valve replacement. We aimed to determine their periprocedural and midterm outcomes and investigate the impact of obesity phenotype.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Consecutive patients who are MO (body mass index, \u226540\u00a0kg\/m\n              <jats:sup>2<\/jats:sup>\n              , or \u226535\u00a0kg\/m\n              <jats:sup>2<\/jats:sup>\n              with obesity\u2010related comorbidities; n=910) with severe aortic stenosis who underwent transcatheter aortic valve replacement in 18 tertiary hospitals were compared with a nonobese cohort (body mass index, 18.5\u201329.9\u00a0kg\/m\n              <jats:sup>2<\/jats:sup>\n              , n=2264). Propensity\u2010score matching resulted in 770 pairs. Pre\u2013transcatheter aortic valve replacement computed tomography scans were centrally analyzed to assess adipose tissue distribution; epicardial, abdominal visceral and subcutaneous fat. Major vascular complications were more common (6.6% versus 4.3%;\n              <jats:italic>P<\/jats:italic>\n              =0.043) and device success was less frequent (84.4% versus 88.1%;\n              <jats:italic>P<\/jats:italic>\n              =0.038) in the MO group. Freedom from all\u2010cause and cardiovascular mortality were similar at 2 years (79.4 versus 80.6%,\n              <jats:italic>P<\/jats:italic>\n              =0.731; and 88.7 versus 87.4%,\n              <jats:italic>P<\/jats:italic>\n              =0.699; MO and nonobese, respectively). Multivariable analysis identified baseline glomerular filtration rate and nontransfemoral access as independent predictors of 2\u2010year mortality in the MO group. An adverse MO phenotype with an abdominal visceral adipose tissue:subcutaneous adipose tissue ratio \u22651 (VAT:SAT) was associated with increased 2\u2010year all\u2010cause (hazard ratio [HR], 3.06; 95% CI, 1.20\u20137.77;\n              <jats:italic>P<\/jats:italic>\n              =0.019) and cardiovascular (hazard ratio, 4.11; 95% CI, 1.06\u201315.90;\n              <jats:italic>P<\/jats:italic>\n              =0.041) mortality, and readmissions (HR, 1.81; 95% CI, 1.07\u20133.07;\n              <jats:italic>P<\/jats:italic>\n              =0.027). After multivariable analysis, a (VAT:SAT) ratio \u22651 remained a strong predictor of 2\u2010year mortality (hazard ratio, 2.78;\n              <jats:italic>P<\/jats:italic>\n              =0.035).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Transcatheter aortic valve replacement in patients who are MO has similar short\u2010 and midterm outcomes to nonobese patients, despite higher major vascular complications and lower device success. An abdominal VAT:SAT ratio \u22651 identifies an obesity phenotype at higher risk of adverse clinical outcomes.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.120.019051","type":"journal-article","created":{"date-parts":[[2021,5,31]],"date-time":"2021-05-31T09:07:57Z","timestamp":1622452077000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":29,"title":["Impact of Morbid Obesity and Obesity Phenotype on Outcomes After Transcatheter Aortic Valve Replacement"],"prefix":"10.1161","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1160-7735","authenticated-orcid":false,"given":"Angela","family":"McInerney","sequence":"first","affiliation":[{"name":"Cardiovascular InstituteHospital Cl\u00ednico San CarlosInstituto de Investigaci\u00f3n Sanitaria San Carlos Madrid 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