Does High Body Mass Index Increase Operative Risk In Minimally-invasive Aortic Valve Replacement?
Joseph George, Umair Aslam, Pankaj Kumar.
Morriston Hospital, Swansea, United Kingdom.
OBJECTIVE: Minimally-invasive aortic valve replacement (mini-AVR) via upper partial sternotomy is increasingly becoming routine. There are trials under way that aim to compare the outcomes of mini-AVR with conventional sternotomy. However, often one of the exclusion criteria is high body mass index (BMI). We compare the outcomes of our high BMI patients to the normal group.
METHODS: A prospective database of operative records between 2006 and 2016 were examined to retrieve all patients who had undergone mini-AVR, including patient demographics, pre-morbid status, intra-operative and post-operative details. Survival data was obtained from the Registry at Welsh Demographic Service. Blood products usage was obtained from the blood bank database. SPSS v23 was used to undertake unpaired t-test with 95% confidence intervals where appropriate to analyse the results. Logistic EuroSCORE was used for risk stratification.
RESULTS: 210 patients who underwent mini-AVR were placed in two groups - group 1 (n=142) with BMI less than 30kg/m2, and group 2 (n=68) with BMI greater than 30kg/m2. The two groups were matched with no significant differences in logistic EuroSCORE, age, ventricular function, sex, renal function and pre-operative haemoglobin.
There were no significant differences in bypass time, cross-clamp time or length of stay between the two groups (p>0.05). Higher BMI patients had fewer units of packed red cell transfusions. (1.70 vs 2.44, p=0.046). There was also no difference between the two groups in the 30-day all-cause mortality, re-exploration rate for bleeding, length of hospital stay and conversion to sternotomy rate.
CONCLUSIONS: We have shown that patients with high BMI can routinely undergo the mini-sternotomy approach for aortic valve replacement. It is associated with a lower need for blood transfusion. High BMI should not be considered to be an exclusion criteria for undertaking mini-AVR. This may be the group to gain the most benefit by reducing the morbidity associated with a full sternotomy.
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