Outcomes Of Minimally Invasive Aortic Valve Replacement In Obese Patients
Fahd BENNANI1, Marie-Catherine MORGANT2, Chloé BERNARD2, Ghislain MALAPERT2, Saed JAZAYERI2, Aline LAUBRIET-JAZAYERI2, Olivier BOUCHOT2.
1Grenoble University Hospital, GRENOBLE, France, 2Dijon University Hospital, DIJON, France.
BACKGROUND: Obesity is a contraindication to aortic valve replacement (AVR) via right anterior thoracotomy (RAT) in many surgical teams. The objective is to analyze the outcomes of patients undergoing isolated AVR via RAT depending on their body mass index (BMI). METHODS: Between November 2009 and December 2020, 572 patients underwent an isolated AVR via RAT. Their data were collected prospectively. A comparison of the patients’ outcomes depending on their BMI was carried out : obese (BMI ≥ 30 kg/m˛) vs non obese (BMI < 30 kg/m˛) patients. RESULTS: Two hundred and five patients (35.8%) were obese. 30 days mortality was similar between the 2 groups (2.9% vs 1.6%, p = 0.30). Obese patients had more chronic obstructive pulmonary disease (3.8% vs 8.3%, p = 0.023), diabetes mellitus (14.7% vs 42.9%, p < 0.0001) and chronic renal insufficiency (2.2% vs 6.3%, p = 0.011). Their Euroscore II was significantly higher (1.86±2.64% vs 1.73±1.82%, p = 0.02). There was no difference in conversion to sternotomy (3.4% vs 1.6%, p = 0.17), duration of aortic clamping (83.6±28.0 min vs 82.2±29.4 min, p = 0.66), reoperation for bleeding (5.9% vs 5.7%, p = 0.94), blood transfusion (33.0% vs 33.7%, p = 0.87), myocardial infarction (1.1% vs 1.5%, p = 0.71), stroke (2.9% vs 2.5%, p = 0.73), permanent pacemaker (3.4% vs 2.2%, p = 0.19), wound infection (2.2% vs 3.4%, p = 0.38) or length of stay in intensive care unit (2.7±2.2 days vs 2.6±3.0 days, p = 0.27). The duration of extracorporeal circulation (118±44 min vs 110±41 min, p = 0.03) and the length of hospital stay (8.9±5.6 days vs 7.9±4.5 days, p = 0.003) were significantly higher in obese patients. They had more new onsets of atrial fibrillation (18.8% vs 26.3%, p = 0.035), pulmonary (5.7% vs 10.7%, p = 0.029), renal (4.1% vs 9.8%, p = 0.007) and femoral (3.8% vs 8.8%, p = 0.013) complications. CONCLUSIONS: Obese patients do not show a higher mortality or morbidity, except for femoral complications. These results suggest that obesity should not be considered as a contraindication to isolated minimally invasive AVR.
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