Low body mass index and risk of mortality after mitral transcatheter edge‐to‐edge repair procedure: The “obesity paradox”

Background Most patients undergoing the mitral transcatheter edge‐to‐edge repair (TEER) technique are elderly comorbid patients. Low body mass index (BMI) 0.05). In a multivariable Cox regression analysis, BMI as a continuous variable (hazard ratio [HR]: 0.93 [95% confidence interval, CI: 0.87–0.99], p = 0.03) and low BMI (HR: 1.99 [95% CI: 1.12–3.52], p = 0.02) were associated with the primary outcome. Low BMI was not significantly associated with major bleeding (subdistribution hazard ratio [SHR]: 2.39 [95% CI: 0.96–5.97], p = 0.06) or admission with heart failure (SHR: 1.06 [95% CI: 0.61–1.88], p = 0.83) during follow‐up with univariable competing risk regression analysis. Conclusion Low BMI is a risk factor for mortality after mitral valve TEER, confirming the presence of an “obesity paradox” in this population and should receive attention in patient selection.