TagedAPREnReaders’ Comments 391

RMST-based results may facilitate AM, DELIVER Trial Committees and Investiga- relevant articles and abstracts published
shared decision-making and may influ- tors. Dapagliflozin in heart failure with mildly from inception to April 2023 that com-
ence treatment adherence.TagedAPTREn reduced or preserved ejection fraction. N Engl J pared TAVR versus SAVR in obese
Med 2022;387:1089–1098TagedAPTREn.TagedAPREn
3TagedAPRListImbl TagedAPREn. TagedAPRListBoyRoyston P, Parmar MKB. Restricted mean sur- patients (body mass index ≥30 kg/m2).
vival time: an alternative to the hazard ratio The primary outcome was in-hospital
TagedAPRH1Clinical Question and FindingsTagedAPTREn for the design and analysis of randomized tri- mortality. Additional outcomes included
TagedAPRWhat is the benefit of SGLT2is in als with a time-to-event outcome. BMC Med acute myocardial infarction, permanent
Res Methodol 2013;13:152TagedAPTREn.TagedAPREn
patients with HFpEF in terms of TagedAPRListImbl4TagedAPREn. TagedAPRListBoyGuyot P, Ades AE, Ouwens MJNM, Welton pacemaker placement, acute kidney
restricted mean survival time?TagedAPTREn NJ. Enhanced secondary analysis of survival injury, postoperative sepsis, and need
TagedAPRWe calculated that SGLT2i led to a data: reconstructing the data from published for blood transfusion.TagedAPTREn
26-day delay in cardiovascular mortal- Kaplan-Meier survival curves. BMC Med Res TagedAPRWe included 3 registry-based and 1
ity or HF hospitalization if taken for Methodol 2012;12:9TagedAPTREn.TagedAPREn multicentric retrospective study in this
TagedAPRListImbl5TagedAPREn. TagedAPRListBoyWeir IR, Tian L, Trinquart L. Multivariate
3 years.TagedAPTREn meta-analysis model for the difference in analysis,4−7 with a total of 37,743
restricted mean survival times. Biostatistics patients. Of those, 8,353 underwent
2021;22:82–96TagedAPTREn.TagedAPREn TAVR and 29,390 underwent SAVR.
TagedAPRH1Data availability statementTagedAPTREn
TAVR patients were older (77 vs
https://doi.org/10.1016/j.amjcard.2023.06.057
agedAPTRThe data supporting the study find- 67 years) and were more frequently
ings are available from the correspond- female (58% vs 44%). In-hospital mor-
ing author upon reasonable request.TagedAPTREn tality was lower in TAVR (odds ratio
TagedAPRH1In-Hospital Outcomes of [OR] 0.64, 95% confidence interval
Transcatheter Aortic [CI] 0.42 to 0.96, p = 0.04, I2 = 64%).
TagedAPRH1Declaration of Competing InterestTagedAPTREn
Valve Replacement TAVR patients also had lower rate of
TagedAPRThe authors have no conflicts of Versus Surgical Aortic acute kidney injury (OR 0.54, 95% CI
interest to declare.TagedAPTREn Valve Replacement in 0.39 to 0.85, p = 0.0002, I2 = 85%),
postoperative sepsis (OR 0.33, 95% CI
ObesityTagedAPTREn
TagedAPRH1FundingTagedAPTREn 0.18 to 0.59, p = 0.0002, I2 = 0%), and
TagedAPRAortic stenosis (AS) is a degenera- lower rate of blood transfusion (OR
TagedAPRNone.TagedAPTREn tive valvular disease that worsens over 0.27, 95% CI 0.15 to 0.49, p <0.0001,
time. Its prevalence has been signifi- I2 = 89%). The need for permanent
Salman Zahid, MDa cantly increasing over the past 2 deca- pacemaker placement, however, was
Safi U. Khan, MD, MSb des and is expected to continue to higher in the TAVR group (OR 2.43,
a
Department of Cardiovascular Medicine, Knights increase with the progressive aging of 95% CI 1.87 to 3.15, p <0.00001,
Cardiovascular Institute, Oregon Health and Science the population in developed countries.1 I2 = 70%). The rate of myocardial
University, Portland, Oregon
b
Department of Cardiovascular Medicine, Houston Aortic valve replacement is currently infarction was similar between both
Methodist DeBakey Heart & Vascular Institute, the mainstay of treatment of AS with groups (OR 0.76, 95% CI 0.34 to 1.67,
Houston, Texas
20 April 2023
improvement in both mortality and p = 0.49, I2 = 88%) (Figure 1).TagedAPTREn
3 June 2023 quality of life. Surgical aortic valve TagedAPRObesity is prevalent in patients with
replacement (SAVR) has been the stan- AS and is associated with increased sur-
dard of care for treatment of AS for gical risk and postoperative complica-
TagedAPRListImbl1TagedAPREn. TagedAPRListBoyAnker SD, Butler J, Filippatos G, Ferreira JP, many years. However, since the intro- tions, including mortality, in patients
Bocchi E, B€ ohm M, Brunner-La Rocca HP,
Choi DJ, Chopra V, Chuquiure-Valenzuela E, duction of transcatheter aortic valve who underwent cardiac surgeries. Our
Giannetti N, Gomez-Mesa JE, Janssens S, replacement (TAVR) in 2002, it has analysis provides evidence that sup-
Januzzi JL, Gonzalez-Juanatey JR, Merkely B, been shown to have similar, or even ports the feasibility and safety of
Nicholls SJ, Perrone SV, Pi~na IL, Ponikowski better, clinical outcomes in patients TAVR in patients with obesity. It also
P, Senni M, Sim D, Spinar J, Squire I, Taddei with at least intermediate surgical risk.2 shows that TAVR is associated with a
S, Tsutsui H, Verma S, Vinereanu D, Zhang J,
Carson P, Lam CSP, Marx N, Zeller C, Sattar Obesity, defined as body mass index higher incidence of permanent pace-
N, Jamal W, Schnaidt S, Schnee JM, Brueck- ≥30 kg/m2, is very prevalent in patients maker placement. This is consistent
mann M, Pocock SJ, Zannad F, Packer M, who are being referred for treatment of with recently published data6 and war-
EMPEROR-Preserved Trial Investigators. severe AS, and recent data has esti- rants caution when selecting the best
Empagliflozin in heart failure with a preserved
ejection fraction. N Engl J Med mated that 13% to 17% of patients therapeutic intervention for this group
2021;385:1451–1461TagedAPTREn.TagedAPREn referred to TAVR are obese.3−5 Evi- of patients. The transfemoral approach,
TagedAPRListImbl2TagedAPREn. TagedAPRListBoySolomon SD, McMurray JJV, Claggett B, de dence supporting the safety of TAVR which has been traditionally utilized for
Boer RA, DeMets D, Hernandez AF, Inzucchi in obese patients, however, is limited TAVR, could theoretically present a
SE, Kosiborod MN, Lam CSP, Martinez F, Shah and the best therapeutic approach in challenge in this patient population and
SJ, Desai AS, Jhund PS, Belohlavek J, Chiang
CE, Borleffs CJW, Comin-Colet J, Dobreanu D, this patient population remains debat- might warrant the use of alternative
Drozdz J, Fang JC, Alcocer-Gamba MA, Al able. We aimed to conduct a meta-anal- access including transradial, transcaval,
Habeeb W, Han Y, Cabrera Honorio JW, Jans- ysis to compare the in-hospital transapical, or transcarotid. More stud-
sens SP, Katova T, Kitakaze M, Merkely B, outcomes between TAVR and SAVR in ies, specifically randomized trials, with
O’Meara E, Saraiva JFK, Tereshchenko SN,
Thierer J, Vaduganathan M, Vardeny O, Verma patients with obesity.TagedAPTREn long-term follow-up and supplementary
S, Pham VN, Wilder€ang U, Zaozerska N, TagedAPRThe PubMed, EMBASE, and analyses of the different categories of
Bachus E, Lindholm D, Petersson M, Langkilde Cochrane databases were searched for obesity, are warranted to further assess
TagedAPREn392
TagedAPRFiur The American Journal of Cardiology (www.ajconline.org)

Figure 1. Forest plot charts of the primary and secondary outcomes of the analysis. M-H = Mantel-Haenszel.TagedAPTREn

the efficacy and safety of TAVR in this Khalid Saeed Al-Asad, MDa,*
group of patients.TagedAPTREn Adolfo Martinez Salazar, MDa
Majid Yavari, MDa
Gabriel Panama, MDa
TagedAPRH1FundingTagedAPTREn Rand Sabanci, MDa
Moiz Saeed, MDa
TagedAPRNone.TagedAPTREn
George Abela, MD, MScb
a
Departments of Internal Medicine, Michigan State
University, East Lansing, Michigan
TagedAPRH1Declaration of Competing InterestTagedAPTREn b
Departments of Cardiology, Michigan State
University, East Lansing, Michigan
TagedAPRThe authors have no conflicts of *
Corresponding author at: Michigan State University
interest to declare.TagedAPTREn - Clinical Center, 788 service road, Room B-301,
East Lansing, Michigan, 48824. (saeedala@msu.
edu).
30 May 2023
14 June 2023
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trends in aortic stenosis incidence and out-
comes. Circulation 2015;131:969–971TagedAPTREn.TagedAPREn
TagedAPRListImbl2TagedAPREn. TagedAPRListBoyChen S, Redfors B, Ben-Yehuda O, Crowley
A, Dvir D, Hahn RT, Pibarot P, Jaber WA,
Webb JG, Yoon S-H, Makkar RR, Alu MC,
Thourani VH, Tuzcu EM, Mack MJ, George I,

Nazif T, Kodali SK, Leon MB. Outcomes of
patients with significant obesity undergoing
TAVR or SAVR in the randomized PART-
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3 soulis A, Takagi H, Grines CL, Afonso L.
Tchetche D, Mieghem NM Van, Buchanan
GL, Vahdat O, Marcheix B, Serruys PW, Faja-
det J, Colombo A, Carrie D, Domburg RT van,
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S, Musumeci F, Barbanti M, Ranucci M, San-
toro G, Badoni G, Fusco D, Ventura M, Tam-
burino C, Seccareccia F. Early and late
TagedAPREnReaders’ Comments
outcomes after transcatheter versus surgical
aortic valve replacement in obese patients.
Arch Med Sci 2020;16:796–801TagedAPTREn.TagedAPREn
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Comparison of in-hospital outcomes of trans-
catheter aortic valve implantation versus surgi-
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mass index ≥ 30 kg/m2) patients. Am J Cardiol
2017;120:1858–1862TagedAPTREn.TagedAPREn
agedAPTRListImbl6TagedAPREn. TagedAPRListBoyMcInerney A, Rodes-Cabau J, Veiga G,
Lopez-Otero D, Mu~noz-Garcıa E, Campelo-
Parada F, Oteo JO, Carnero M, Tafur Soto
JTS, Amat-Santos IAS, Travieso A, Moham-
madi S, Barbanti M, Cheema AC, Toggweiler
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