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The Benefits of Port Access Mitral Valve Surgery Can Be Safely Offered to Morbidly Obese Patients
Pavan Atluri, Ann C. Gaffey, Wilson Y. Szeto, W.Clark Hargrove.
University of Pennsylvania, Philadelphia, PA, USA.

Objective: Minimally invasive, port access, approaches to mitral valve surgery have demonstrated equivalent technical outcomes, minimal wound infections, and more rapid recovery when compared to traditional sternotomy. Morbidly obese patients have an increased risk of sternal dehiscence and slower recovery given their body habitus. There may be concern offering this approach to the morbidly obese given the added complexity and more difficult exposure. We hypothesized that this approach can be safely performed in the morbidly obese (BMI ≥35) with rapid post-operative recovery.
Methods: Patients undergoing minimally invasive mitral valve surgery at our center from 1998 to 2013 were analyzed. During this time 1046 patients underwent minimally invasive, port access, mitral valve surgery. The morbidly obese (BMI ≥35, n=73) were compared to those patients with normal body habitus (BMI<35, n=973). Pre-operative, intra-operative, and post-operative variables were compared between cohorts [TABLE].
Results: Morbidly obese patients were able to safely undergo mitral valve surgery with minimal mortality (1.37 vs. 2.46%, p=NS) and morbidity [TABLE] that was comparable to patients with normal body habitus. Post-operative recovery was similar between obese and normal body habitus patients as noted by time to extubation (10.6±14.4 vs. 11.2±36.9 hrs, p=NS) and hospital length of stay (8.2±3.9 vs. 7.6±6.0 days, p=NS). There were no deep wound infections noted in the morbidly obese patients. Interestingly, morbidly obese patients had a significantly lower transfusion requirement when compared to normal body habitus patients (p=0.007).
Conclusion: Minimally invasive, port-access, mitral valve surgery can be safely performed in morbidly obese patients with excellent outcomes. This approach avoids concerns of sternal instability and dehiscence that can complicate traditional mitral surgery via sternotomy.
VariableMorbid Obesity (n=73)Normal Body Habitus (n=973)p=
Age (years)56 ± 1160±130.007
BMI (kg/m2)39.7 ± 8.725.7±3.9<0.000001
Ejection Fraction (%)52.6±12.152.7±3.90.08
Diabetes (%)20.5%6.7%0.0002
NYHA Class III or IV (%)49.3%31.1%0.003
Cardiopulmonary bypass time (min)136±39146±360.009
Cross-clamp time (min)99±39106±320.07
Concomitant Cryomaze (%)23.2%20.4%0.6
Reexploration (%)4.1%6.0%0.7
Transfusion (%)15.1%33.9%0.0007

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