Predictive Value of Body Mass Index in Minimally Invasive Mitral Valve Surgery
Background With this study we aimed to analyze if the separate consideration of body mass index (BMI) could provide any superior predictive values compared with the established risk scores in isolated minimally invasive mitral valve surgery (MIMVS). This might facilitate future therapeutic decision-making, e.g., regarding the question surgery versus transcatheter mitral valve repair (TMVr).
Methods We assessed the relevance of BMI in non-underweight patients who underwent isolated MIMVS. The risk predictive potential of BMI for mortality and several postoperative adverse events was assessed in 429 consecutive patients. This predictive potential was compared with that of European System for Cardiac Outcome Risk Evaluation II (EuroSCORE II) and the Society of Thoracic Surgeons score (STS score) using a comparative receiver operating characteristic curve analysis.
Results BMI was a significant numeric predictor of wound healing disorders (p = 0.001) and proved to be significantly superior in case of this postoperative adverse event compared with the EuroSCORE II (p = 0.040) and STS score (p = 0.015). Except for this, the predictive potential of BMI was significantly inferior compared with that of the EuroSCORE II and STS score for several end points, including 30-day (p = 0.029 and p = 0.006) and 1-year (p = 0.012 and p = 0.001) mortality.
Conclusion Therefore, we suggest that, in the course of decision-making regarding the right treatment modality for non-underweight patients with isolated mitral valve regurgitation, the sole factor of BMI should not be given a predominant weight.
Received: 30 September 2020
Accepted: 07 January 2021
12 February 2021 (online)
© 2021. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
- 1 Finucane MM, Stevens GA, Cowan MJ. et al; Global Burden of Metabolic Risk Factors of Chronic Diseases Collaborating Group (Body Mass Index). National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9·1 million participants. Lancet 2011; 377 (9765): 557-567
- 2 Mariscalco G, Wozniak MJ, Dawson AG. et al. Body mass index and mortality among adults undergoing cardiac surgery: a nationwide study with a systematic review and meta-analysis. Circulation 2017; 135 (09) 850-863
- 3 Reeves BC, Ascione R, Chamberlain MH, Angelini GD. Effect of body mass index on early outcomes in patients undergoing coronary artery bypass surgery. J Am Coll Cardiol 2003; 42 (04) 668-676
- 4 Stamou SC, Nussbaum M, Stiegel RM. et al. Effect of body mass index on outcomes after cardiac surgery: is there an obesity paradox?. Ann Thorac Surg 2011; 91 (01) 42-47
- 5 Filardo G, Hamilton C, Hamman B, Ng HK, Grayburn P. Categorizing BMI may lead to biased results in studies investigating in-hospital mortality after isolated CABG. J Clin Epidemiol 2007; 60 (11) 1132-1139
- 6 Ghanta RK, LaPar DJ, Zhang Q. et al. Obesity increases risk-adjusted morbidity, mortality, and cost following cardiac surgery. J Am Heart Assoc 2017; 6 (03) e003831
- 7 Maisano F, Franzen O, Baldus S. et al. Percutaneous mitral valve interventions in the real world: early and 1-year results from the ACCESS-EU, a prospective, multicenter, nonrandomized post-approval study of the MitraClip therapy in Europe. J Am Coll Cardiol 2013; 62 (12) 1052-1061
- 8 Feldman T, Kar S, Elmariah S. et al; EVEREST II Investigators. Randomized comparison of percutaneous repair and surgery for mitral regurgitation: 5-year results of EVEREST II. J Am Coll Cardiol 2015; 66 (25) 2844-2854
- 9 Baumgartner H, Falk V, Bax JJ. et al; ESC Scientific Document Group. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J 2017; 38 (36) 2739-2791
- 10 Nashef SA, Roques F, Sharples LD. et al. EuroSCORE II. Eur J Cardiothorac Surg 2012; 41 (04) 734-744 , discussion 744–745
- 11 Shahian DM, Jacobs JP, Badhwar V. et al. The Society of Thoracic Surgeons 2018 adult cardiac surgery risk models: part 1-background, design considerations, and model development. Ann Thorac Surg 2018; 105 (05) 1411-1418
- 12 Reser D, Sündermann S, Grünenfelder J. et al. Obesity should not deter a surgeon from selecting a minimally invasive approach for mitral valve surgery. Innovations (Phila) 2013; 8 (03) 225-229
- 13 Rapetto F, Bruno VD, King M. et al. Impact of body mass index on outcomes following mitral surgery: does an obesity paradox exist?. Interact Cardiovasc Thorac Surg 2018; 26 (04) 590-595
- 14 World Health Organization. Obesity: Preventing and Managing the Global Epidemic; Report of a WHO Consultation (WHO Technical Report Series 894). Geneva: World Health Organization; 2000
- 15 Minol JP, Dimitrova V, Petrov G. et al. The age-adjusted Charlson comorbidity index in minimally invasive mitral valve surgery. Eur J Cardiothorac Surg 2019; 56 (06) 1124-1130 . doi:10.1093/ejcts/ezz240
- 16 Green D, Swets J. Signal Detection Theory and Psychophysics. New York, NY: John Wiley and Sons; 1966
- 17 Metz CE. Basic principles of ROC analysis. Semin Nucl Med 1978; 8 (04) 283-298
- 18 Swets JA. ROC analysis applied to the evaluation of medical imaging techniques. Invest Radiol 1979; 14 (02) 109-121
- 19 Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 1982; 143 (01) 29-36
- 20 Hanley JA, McNeil BJ. A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology 1983; 148 (03) 839-843
- 21 Levin A, Stevens PE, Bilous RW. et al. Kidney disease: improving global outcomes (KDIGO) CKD work group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl 2013; 3: 1-150
- 22 Lancellotti P, Tribouilloy C, Hagendorff A. et al; Scientific Document Committee of the European Association of Cardiovascular Imaging. Recommendations for the echocardiographic assessment of native valvular regurgitation: an executive summary from the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2013; 14 (07) 611-644
- 23 Baumgartner H, Hung J, Bermejo J. et al; American Society of Echocardiography, European Association of Echocardiography. Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice. J Am Soc Echocardiogr 2009; 22 (01) 1-23 , quiz 101–102
- 24 Santana O, Reyna J, Grana R, Buendia M, Lamas GA, Lamelas J. Outcomes of minimally invasive valve surgery versus standard sternotomy in obese patients undergoing isolated valve surgery. Ann Thorac Surg 2011; 91 (02) 406-410
- 25 Karkouti K, Wijeysundera DN, Yau TM. et al. Acute kidney injury after cardiac surgery: focus on modifiable risk factors. Circulation 2009; 119 (04) 495-502
- 26 Lanzetti RM, Lupariello D, Venditto T. et al. The role of diabetes mellitus and BMI in the surgical treatment of ankle fractures. Diabetes Metab Res Rev 2018; 34 (02) e2954
- 27 Al-Sarraf N, Raza A, Rowley S. et al. Short-term and long-term outcome in low body mass index patients undergoing cardiac surgery. Gen Thorac Cardiovasc Surg 2009; 57 (02) 87-93
- 28 Kalbacher D, Tigges E, Boekstegers P. et al. Underweight is associated with inferior short and long-term outcomes after MitraClip implantation: results from the German TRAnscatheter mitral valve interventions (TRAMI) registry. Am Heart J 2020; 222: 73-82