Impact of Body Mass Index on In-Hospital Outcomes After Transcatheter Aortic Valve Replacement: A Retrospective Cohort Study from Saudi Arabia

Body mass index (BMI) has shown inconsistent associations with outcomes after transcatheter aortic valve replacement (TAVR), and evidence from the Middle Eastern population is limited. This study evaluated whether BMI independently predicts early complications, mortality, or infection following TAVR in a Saudi Arabian cohort. We conducted a retrospective analysis of 197 patients who underwent TAVR between 2015 and 2024, stratified by BMI < 25, 25–29.9, and ≥30 kg/m2. The primary endpoint was the in-hospital Valve Academic Research Consortium-3 (VARC-3) composite safety outcome, with secondary outcomes including individual complications, infection, length of stay, and 30-day mortality or readmission. Overall, patients had a mean age of 74.9 ± 8.8 years and 52.3% were female; in-hospital mortality was 2.0%, technical success 99%, and 30-day readmission 12.7%. BMI category was not independently associated with in-hospital complications or mortality, while advanced age ≥ 75 years (adjusted OR 2.52, p = 0.009), moderate Society of Thoracic Surgeons (STS) risk (adjusted OR 3.75, p = 0.008), and high STS risk (adjusted OR 2.26, p = 0.033) independently predicted complications. Overweight patients had higher in-hospital infection rates (14.1% vs. ~3%, p = 0.020). These findings suggest that physiologic vulnerability and operative risk, rather than BMI alone, should guide early TAVR risk assessment.