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Fully-endoscopic Mitral Valve Surgery In Obese Patients
Oliver D. Bhadra, Jonas Pausch, Xiaoqin Hua, Andreas Schäfer, Hermann Reichenspurner, Lenard Conradi;
University Heart and Vascular Center Hamburg, Hamburg, Germany
BACKGROUND:Obesity may challenge surgeons performing fully-endoscopic mitral valve surgery (EMS) and affect clinical outcomes. Therefore, the aim of this study was to evaluate the outcome of pre-obese and obese patients undergoing EMS at our center.
METHODS: From 2015 -2021, 1.029 consecutive patients underwent EMS including cases with concomitant tricuspid valve repair, atrial ablation and left atrial appendage closure. Patients were stratified by normal-weight (group 1 = BMI 18.5-24.9, n=556), pre-obese (group 2 = BMI 25-29.9, n=369) and obese (group 3 = BMI ≥30, n=104).
RESULTS: Severe mitral regurgitation was the main indication in the overall cohort (97.8%). Mitral valve repair and replacement were performed in 92.9 and 7.1%, respectively. There were no significant differences in the rate of concomitant atrial ablation between groups (group 1 vs. 2 vs. 3: 17.7 vs. 22.3 vs. 23.3%, p=0.15) or concomitant tricuspid valve repair (9.0 vs. 6.5 vs. 5.8%, p=0.33). Cardiopulmonary bypass time (CPBT) and cross clamp time (CCT) were significantly higher in group 2 and 3 (CPBT: 158.0 (134.0, 188.6) vs. 167.0 (142.0, 201.3) vs. 170.0 minutes (135.0, 207.8), p<0.01; CCT: 94.0 (76.0, 117.8) vs. 103.0 (81.0, 123.0) vs. 99.0 minutes (77.2, 122.7), p<0.01). The overall rate of wound healing disorders was very low at 0.8% with no significant differences between groups. Moreover, rate of re-thoracotomy showed no significant differences between groups (7.2 vs. 7.3 vs. 6.8%, p=0.98). The rate of residual mitral valve insufficiency >mild was very low in all groups (1.6 vs. 2.4 vs. 2.9%, p=0.82). There was a very low mortality rate in all groups (0.5 vs. 0.5 vs. 1.0%, p=0.87).
CONCLUSIONS:
EMS can be safely performed in pre-obese and obese patients with favourable clinical and hemodynamic results despite prolonged cardiopulmonary bypass and aortic cross-clamp times.
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