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Published on: May 26, 2023
Obesity should not deter a surgeon from selecting a minimally invasive approach for mitral valve surgery
Diana Reser1, Simon Sündermann, Jürg Grünenfelder
1Department of Cardiovascular Surgery, University Hospital Zürich, Zürich, Switzerland. diana.reser@usz.ch
Objective:
Obesity is highly prevalent in modern patient populations. Several studies have published conflicting outcomes after minimally invasive surgery with regard to morbidity and mortality. Some instances consider obesity as a relative contraindication for this approach because of inadequate exposure of the surgical field. Our aim was to investigate the outcomes of minimally invasive mitral valve surgery through a right lateral minithoracotomy in patients with a body mass index (BMI) of 30 kg/m2 or greater.
Methods:
We conducted a retrospective database review between January 1, 2009, and December 31, 2011. Preoperative, intraoperative, postoperative, and follow-up data of 225 consecutive patients were collected.
Results:
The patients were stratified according to their BMI: 108 had a normal weight with a BMI of lower than 25 kg/m2 (18-24), 90 were overweight with a BMI of 25 to 29 kg/m2, and 27 were obese with a BMI of 30 kg/m2 (30-41) or greater. Statistical analysis showed significantly longer ventilation times in the obese group, whereas all other variables were similar. Survival, major adverse cardiac and cerebrovascular event-free survival, valve competency, and freedom from reoperation were also comparable.
Conclusions:
Our data suggest that obesity should not deter a surgeon from selecting a minimally invasive approach. Despite longer postoperative ventilation times, a BMI of 30 kg/m2 or greater does not influence short- and medium-term outcome. Obese patients may even benefit from this approach because it avoids the need for sternotomy and therefore reduces the risk for sternal wound infection.
Insights
Minimally invasive mitral valve surgery is safe for obese patients (body mass index ≥ 30 kg/m2). Despite longer ventilation times, obesity does not impact survival or adverse events, potentially reducing sternal wound infection risk.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Surgery
- Obesity Medicine
Background:
- Obesity is a growing concern in patient populations.
- Outcomes of minimally invasive surgery in obese patients are debated.
- Obesity is sometimes considered a contraindication due to surgical field exposure challenges.
Purpose of the Study:
- To evaluate the outcomes of minimally invasive mitral valve surgery in patients with a body mass index (BMI) of 30 kg/m2 or greater.
- To compare outcomes between obese and non-obese patients undergoing this procedure.
Main Methods:
- Retrospective database review from January 1, 2009, to December 31, 2011.
- Collected preoperative, intraoperative, postoperative, and follow-up data for 225 patients.
- Stratified patients into normal weight (<25 kg/m2), overweight (25-29 kg/m2), and obese (≥30 kg/m2) groups.
Main Results:
- Obese patients (n=27) experienced significantly longer ventilation times compared to normal weight (n=108) and overweight (n=90) groups.
- Survival, major adverse cardiac and cerebrovascular event-free survival, valve competency, and freedom from reoperation were comparable across all BMI groups.
- No significant differences in other intraoperative or postoperative variables were observed.
Conclusions:
- Obesity (BMI ≥ 30 kg/m2) should not be a deterrent for selecting minimally invasive mitral valve surgery.
- While ventilation times may be longer, obesity does not negatively affect short- and medium-term outcomes.
- Minimally invasive approaches may benefit obese patients by avoiding sternotomy and reducing sternal wound infection risk.
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