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Outcomes of Minimally Invasive Aortic Valve Replacement in Obese Patients: A Propensity-Matched Study

Federico Cammertoni1,2, Piergiorgio Bruno1,2, Natalia Pavone1

  • 1Department of Cardiovascular Sciences, Cardiac Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.

Brazilian Journal of Cardiovascular Surgery
|March 1, 2024
PubMed

Insights

Minimally invasive aortic valve replacement (MIAVR) is safe and effective for obese patients, offering faster recovery and shorter intensive care unit stays compared to conventional methods. This approach improves respiratory outcomes and should be considered for this patient group.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Minimally Invasive Surgery

Background:

  • Obesity increases risks for cardiac surgery complications.
  • Evaluating alternative surgical approaches is crucial for patient safety and outcomes.

Purpose of the Study:

  • To assess the safety and efficacy of minimally invasive aortic valve replacement (MIAVR) via upper sternotomy in obese patients.
  • To compare MIAVR with conventional aortic valve replacement (CAVR) in this specific population.

Main Methods:

  • Retrospective review of 203 obese patients undergoing elective aortic valve replacement (January 2014-January 2023).
  • Comparison between 106 MIAVR patients and 97 CAVR patients.
  • Propensity-matched analysis created two balanced groups of 91 patients each to control for baseline differences.

Main Results:

  • No significant difference in 30-day mortality between MIAVR and CAVR groups (1.1% vs. 0%, P=0.99).
  • MIAVR demonstrated significantly faster extubation (6 ± 2 vs. 9 ± 2 hours, P<0.01) and reduced need for continuous positive airway pressure therapy (3.3% vs. 13.2%, P=0.03).
  • Intensive care unit stay was shorter for MIAVR patients (1.8 ± 1.2 vs. 3.2 ± 1.4 days, P<0.01), with comparable long-term survival (logrank P=0.58).

Conclusions:

  • Minimally invasive aortic valve replacement via upper sternotomy is a safe and effective option for obese patients.
  • The approach offers significant benefits in respiratory outcomes, including reduced mechanical ventilation time and post-extubation support.
  • Shorter intensive care unit stays suggest MIAVR is advantageous for obese individuals, and this approach should not be withheld.
Abstract

Keywords:
Airway ExtubationAortic ValveArtificial RespirationLength of StayMinimally Invasive Surgical ProceduresObesityPostoperative Complications

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