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OBJECTIVE: Obesity is a well-known risk factor for patients undergoing cardiac surgery. In particular, morbid-obesity (BMI greater than 35) usually confers a higher pre-operative risk. Robotic heart surgery may have many advantages for these high-risk patients. We investigated the outcomes of robotic cardiac surgery in morbidly obese patients.
METHODS: We retrospectively reviewed patients undergoing robotic cardiac surgery (n=421) from July 2013 to November 2016 at our institution. We summarized perioperative data, and compared the outcomes of obese and morbidly-obese patients versus non-obese patients.
RESULTS: Total of 421 patients underwent robotic cardiac surgery (282 male, median age 64 years old). The robotic procedures were: totally endoscopic coronary artery bypass (N=230), mitral valve repair, or replacement (N=118), arrhythmia surgery (N=66), atrial septal defect closure (N=28), tricuspid valve repair (N=14), pericardectomy (N=10), and others (N=20). Incidence of postoperative prolonged ventilation (> 24 hours), wound problems, acute kidney injury, stroke, and new atrial fibrillation were 8.6 %, 1.0 %, 2.4 %, 0.5 %, and 17.6 % respectively. Mean length of ICU stay and hospital stay was 2.15 ± 4.37, and 4.57 ± 5.82 days, respectively. Mortality was 1.7 % (7/421). Mean BMI was 29.1 ± 6.9 in all patients. The cohorts were divided into 4 groups; normal weight (BMI < 25, N=107), overweight (BMI 25-30, N=166), obesity (BMI 30-35, N=85), and morbid-obesity (BMI > 35, N=63). Morbid-obesity compared with normal weight had a higher rate of hypertension, dyslipidemia, and diabetes mellitus preoperatively. There was no statistically significant difference in incidence of prolonged ventilation, wound problems, acute kidney injury, stroke, new atrial fibrillation, length of ICU and hospital stay, and mortality among the groups.
CONCLUSIONS: Outcomes of robotic heart surgery in morbidly-obese patients in our center were acceptable. Over a broad range of cardiac surgical procedures, morbid-obesity was not associated with increased perioperative morbidity, or mortality when these procedures were performed using a robotic approach. These findings can be beneficial in managing this challenging group of patients
LEGEND; Postoperative outcomes

Postoperative outcomes

variables	All patients (n=421)	BMI < 25 (n=107)	BMI 25-30 (n=166)	BMI 30-35 (n=85)	BMI >35 (n=63)	P value
Complications, n	103 (24.5%)	24 (22.4%)	44 (26.5%)	17 (20.0%)	18 (28.6%)	0.551
Prolonged ventilation (> 24h), n	36 (8.6%)	11 (10.3%)	13 (7.9%)	4 (4.7%)	8 (12.7%)	0.322
Wound problem, n	4 (1.0%)	0 (0%)	1 (0..6%)	1 (1.2%)	2 (3.2%)	0.204
Acute kidney injury, n	10 (2.4%)	3 (2.8%)	2 (1.2%)	2 (2.4%)	3 (4.8%)	0.455
New atrial fibrillation, n	74 (17.6%)	14 (13.1%)	35 (21.1%)	14 (16.5%)	11 (17.5%)	0.396
Stroke or TIA, n	3 (0.7%)	1 (0.9%)	2 (1.2%)	0 (0%)	0 (0%)	0.743
ICU length of stay, day	2.14 ± 4.37	2.36 ± 6.21	2.04 ± 3.62	2.16 ± 4.30	2.03 ± 1.99	0.504
Hospital length of stay, day	4.61 ± 5.97	5.12 ± 7.90	4.35 ± 5.19	4.53 ± 5.84	4.51 ± 3.88	0.701
Mortality, n	7 (1.7%)	2 (1.9%)	2 (1.2%)	1 (1.2%)	2 (3.2%)	0.742