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Published on: May 21, 2017
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Do obese patients benefit from isolated aortic valve replacement through a partial upper sternotomy?
Xian-Biao Xie1,2,3, Xiao-Fu Dai1,2,3, Zhi-Huang Qiu1,2,3
1Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, Fujian, China.
Journal of Cardiothoracic Surgery
|August 3, 2022
Summary
Partial upper sternotomy aortic valve replacement (mini-AVR) is safe and effective for obese patients. This approach reduced blood loss, transfusions, and intensive care unit (ICU) stay compared to conventional full sternotomy aortic valve replacement (con-AVR).
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Surgery
Background:
- Obesity presents unique challenges for conventional aortic valve replacement (AVR).
- Partial upper sternotomy (mini-AVR) is an alternative surgical approach for AVR, but its efficacy in obese patients remains debated.
Purpose of the Study:
- To compare the clinical outcomes of mini-AVR versus conventional full sternotomy AVR (con-AVR) in obese patients.
- To evaluate the safety and effectiveness of mini-AVR in this specific patient population.
Main Methods:
- Retrospective observational study (2015-2020) including 184 obese patients (BMI ≥ 30 kg/m²) undergoing isolated primary AVR.
- 98 patients had con-AVR, and 86 had mini-AVR.
- Propensity score matching created two groups of 60 patients each for analysis.
Main Results:
- No in-hospital mortality in either group.
- Similar cardiopulmonary bypass and total operative times.
- Shorter aortic cross-clamp time in con-AVR (P=.022).
- Significantly lower mediastinal drainage (P=.018) and postoperative blood transfusions (P=.014) in the mini-AVR group.
- Shorter intensive care unit (ICU) stay in the mini-AVR group (P=.021).
Conclusions:
- Mini-AVR is a safe and effective alternative for AVR in obese patients.
- Mini-AVR demonstrates advantages over con-AVR regarding reduced blood loss, transfusion requirements, and shorter ICU duration.
