Mini-AVR Offers Superior Respiratory Outcomes And Mitigates Atrial Fibrillation In Women With High Body Mass Index
Lakshmi Srinivasan, Mohammed Hossain, Gautam Puranik, Ravish Jeeji, Lognathen Balacumaraswami.
Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom.
OBJECTIVE: Incidence of respiratory complications in cardiac surgery following complete sternotomy ranges between 8%-79% and post-operative atrial fibrillation occurs in 30%-50%. Morbidity and mortality in women with high body mass index (BMI>25) is of significant concern. We sought to explore the value of minimally invasive aortic valve replacement (mini-AVR) utilising partial upper sternotomy approach and its effect on post-operative outcomes in this group of patients.
METHODS: All patients undergoing isolated AVR in a single surgeon’s practice were included. Data was recorded prospectively between October 2010 and September 2016 in the National Adult Cardiac Surgical Database. Female patients with BMI >25 undergoing AVR were analysed in two groups - upper partial sternotomy and complete sternotomy.
RESULTS: Isolated AVR was performed on 165 consecutive patients between October 2010 and September 2016. Of these, 17 patients underwent mini-AVR with an inverted J-shaped partial upper sternotomy. Only female patients with BMI >25 (overweight and obese) were analysed for post-operative outcomes. The results are summarised in Table 1. No differences in use of blood and blood products were observed between the two groups. There was neither respiratory complication nor mortality in the mini-AVR group.
CONCLUSIONS: In this study respiratory complications are conspicuous by their absence in the mini-AVR group despite the high risk population with a median BMI 34.6. Due to relatively small numbers of patients in the study the analysis does not reach statistical significance. However, the rate of respiratory complications (0% vs 15.5%) in this high BMI group has significant clinical impact. Partial upper sternotomy approach avoids mobility of the sternal plates, maintains the integrity of the chest wall and preserves the mechanics of the diaphragm. Furthermore, the incidence of post-operative atrial fibrillation is significantly less (p-value 0.03) with the minimally invasive approach which may be related to the limited handling of the heart. Our study supports the safety and feasibility of minimally invasive AVR in women with high body mass index.
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