Is Obesity Associated With Poorer Outcomes In Patients Undergoing Minimally Invasive Mitral Valve Repair?
Firas Al. Aljanadi, Thomas Theologou, Matthew Shaw, Paul Modi.
Liverpool Heart and Chest Hospital, Liverpool, United Kingdom.
BACKGROUND: High body mass index (BMI) can make minimally invasive mitral valve surgery (MIMVS) technically challenging and some surgeons consider this as a contraindication to this technique. The aim of our study was to compare the clinical outcomes of those undergoing MIMVS stratified by body mass index (BMI). METHODS: We included all patients (n=296) undergoing a right mini-thoracotomy approach for mitral/tricuspid valve repair ± cryomaze ± myxoma resection between March 2011 and September 2018. Data are presented as median (interquartile range) or percentages. RESULTS : Patients with a BMI ≥30 kg/m2 (range 30-43.6) (group 1, n=41) were compared to those with BMI ˂30 kg/m2 (17.6-29.9) (group 2, n=255). Comparing 18 preoperative variables, the only significant difference between the two groups was a higher rate of myocardial infarction in group 1 (9.8% vs 2.0%, p=0.02). There was no significant difference between the two groups in any intra-operative or post-operative outcomes (all data group 1 vs group 2, respectively): aortic cross clamp time: 122 (100-141) min vs125 (105-146) min, p=0.72; cardiopulmonary bypass time: 196 (168-214) min vs 185 (161-211) min, p=0.46; mortality: 0 vs 1, p >0.99 ; stroke: no incidence in either group; conversion to sternotomy : 0% vs 2.4% , p >0.99 ; re-exploration for bleeding : 2.4% vs 4.7%, p >0.99 ; ICU stay : 3 (2-4) days vs 3 (2-4) days, p = 0.34; hospital length of stay : 6 (6-9) vs 6 (5-8) days , p= 0.34 . CONCLUSIONS: High BMI is not associated with poorer outcomes in patients undergoing minimally invasive mitral valve repair and, in experienced hands, should not be considered a contraindication to this technique.
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