Minimally Invasive Surgery in Obese Patients
Tamer Ayed1, Wael Mobkhat1, Walid Ragab1, Sherif Orieby1, Ayman Sabry1, Mark Anderson2.
1Galaa Medical Center, Cairo, Egypt, 2Hackensack University Medical Center, Hackensack, NJ, USA.
Background: Less invasive cardiac surgery has become an accepted approach for isolated valve procedures. However, many institutions reserve this approach for ideal candidates. In specific, obese patients are traditionally not offered this technique. Our philosophy has been that all patients are eligible for a less invasive procedure. The purpose of this review was to examine the outcomes of less invasive cardiac surgery in obese patients and determine if this approach is warranted. Methods: All patients undergoing less invasive valve surgery from January 2011 to June 2018 were identified. The charts of patients were reviewed for demographics as well as operative data and post-operative outcomes. Body mass index was calculated for each patient. For purposes of comparison three groups were created. Group A had a BMI < 35, Group B 35-40 (obese) and Group C > 40 (morbidly obese). These groups were compared for differences in operative variables including cross clamp and cardiopulmonary bypass times as well as post-operative outcomes which included intubation times as well as ICU and hospital LOS. Post- operative complications including bleeding (return to OR) and infection (surgical wound) were also collected. Results: A total of 219 patients were reviewed. The procedures included both isolated and multiple valve procedures. Twenty-five procedures were reoperations (11)%. There were 172 in Group A (79%), 32 in Group B (15%) and 15 in Group C (6%). The mean BMI in Group A was 27.7, 38.1 in Group B and 43.1 in Group C. The operative data and postoperative variables are shown in the table. Major complications (stroke, AKI req HD, reoperation) were seen in 5.2% (9) of Group A, 3.1% (1) of Group B and 13.4% (2) of Group C.
|Group A||Group B||Group C|
|X-Clamp time (min)||110||121||149|
|CPB time (min)||278||291||322|
|Intubation time (hours)||6.1||6.8||8|
|ICU LOS (hours)||50.1||48.1||55.2|
|Hospital LOS (days)||7.4||6.7||8.4|
|Mortality||8.14% (14)||3.1% (1)||6.7% (1)|
|Wound Infection||4.1% (7)||0||13.4 (2)|
Conclusions: When compared to non-obese patients, there are no statistically different outcomes with less invasive cardiac surgery in obese and morbidly obese patients. These results would suggest that less invasive cardiac surgery is feasible and should be offered to patients with a high BMI. Further comparison to outcomes with traditional surgical approaches in these patients may be warranted as this approach may be beneficial.
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