Outcomes Of Obese Patients Undergoing Minimally Invasive Aortic Valve Replacement
Marlena E. Sabatino, Lauren A. Salgueiro, Alexis K. Okoh, Joshua Chao, Jigesh Baxi, Fady Soliman, Cassandra Soto, Hirohisa Ikegami, Anthony Lemaire, Mark J. Russo, Leonard Y. Lee.
Robert Wood Johnson University Hospital, Department of Surgery, Division of Cardiothoracic Surgery; Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
Background: Outcomes in minimally invasive aortic valve replacement (mini-AVR) are comparable between obese and non-obese patients. The objective of this study is to investigate the safety and utility of mini-AVR among obese patients stratified into separate groups by level of obesity. Methods: A single center retrospective cohort study of obese patients who underwent mini-AVR through partial sternotomy or minithoracotomy between 2012 and 2018 was conducted. Subjects were stratified into 3 groups according to World Health Organization classifications of obesity: obesity class I: (BMI: 30.0 kg/m2 - 34.9 kg/m2), class II: (BMI: 35 kg/m2 - 39.9 kg/m2), and obesity class III: (BMI ≥ 40 kg/m2). Baseline clinical characteristics and intra and post-operative outcomes were compared among groups. Additional outcomes investigated included direct procedure costs and 30-day readmission rates. Results: During the study period, a total of 250 obese patients underwent mini-AVR including 139 obesity class I, 64 class II, and 47 class III subjects. The mean ± SD BMI of obesity class I, II, and III groups were 32 ± 1.4, 37 ± 1.3, and 44 ± 4 kg/m2 (p<0.0001), respectively. Baseline clinical characteristics were comparable among groups (age: p=0.319, STS risk score: p=0.819) except for sex (p=0.051). Compared to class I (39% female) and II (40% female), class III subjects were predominantly female (59%). Intra and peri-operative outcomes were comparable among all 3 groups. The mean post-operative hospital length of stay (LOS) was longer for class III subjects than for subjects in either class II or I (9 vs. 6 vs. 6 days; p=0.016), respectively. Direct procedural costs ($33,422 in class I subjects, $27,678 in class II subjects, versus $35,012 in class III subjects; p=0.275) and 30-day readmission rates (10% in class I, 12% in class II, versus 13% in class III subjects; p=0.799) differed, but these differences were not statistically significant. Conclusions: Mini-AVR is safe and feasible among obesity classes with similar intra and peri-operative outcomes. Although morbidly obese patients reported an increased LOS, this increased LOS did not translate into higher direct costs or short-term readmission rates
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