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Obesity should not deter a surgeon from selecting a minimally invasive approach for mitral valve surgery


Reser, Diana; Sündermann, Simon; Grünenfelder, Jürg; Scherman, Jacques; Seifert, Burkhardt; Falk, Volkmar; Jacobs, Stephan (2013). Obesity should not deter a surgeon from selecting a minimally invasive approach for mitral valve surgery. Innovations : Technology And Techniques In Cardiothoracic And Vascular Surgery, 8(3):225-229.

Abstract

OBJECTIVE: Obesity is highly prevalent in modern patient populations. Several studies have published conflicting outcomes after minimally invasive surgery with regard to morbidity and mortality. Some instances consider obesity as a relative contraindication for this approach because of inadequate exposure of the surgical field. Our aim was to investigate the outcomes of minimally invasive mitral valve surgery through a right lateral minithoracotomy in patients with a body mass index (BMI) of 30 kg/m or greater. METHODS: We conducted a retrospective database review between January 1, 2009, and December 31, 2011. Preoperative, intraoperative, postoperative, and follow-up data of 225 consecutive patients were collected. RESULTS: The patients were stratified according to their BMI: 108 had a normal weight with a BMI of lower than 25 kg/m (18-24), 90 were overweight with a BMI of 25 to 29 kg/m, and 27 were obese with a BMI of 30 kg/m (30-41) or greater. Statistical analysis showed significantly longer ventilation times in the obese group, whereas all other variables were similar. Survival, major adverse cardiac and cerebrovascular event-free survival, valve competency, and freedom from reoperation were also comparable. CONCLUSIONS: Our data suggest that obesity should not deter a surgeon from selecting a minimally invasive approach. Despite longer postoperative ventilation times, a BMI of 30 kg/m or greater does not influence short- and medium-term outcome. Obese patients may even benefit from this approach because it avoids the need for sternotomy and therefore reduces the risk for sternal wound infection.

Abstract

OBJECTIVE: Obesity is highly prevalent in modern patient populations. Several studies have published conflicting outcomes after minimally invasive surgery with regard to morbidity and mortality. Some instances consider obesity as a relative contraindication for this approach because of inadequate exposure of the surgical field. Our aim was to investigate the outcomes of minimally invasive mitral valve surgery through a right lateral minithoracotomy in patients with a body mass index (BMI) of 30 kg/m or greater. METHODS: We conducted a retrospective database review between January 1, 2009, and December 31, 2011. Preoperative, intraoperative, postoperative, and follow-up data of 225 consecutive patients were collected. RESULTS: The patients were stratified according to their BMI: 108 had a normal weight with a BMI of lower than 25 kg/m (18-24), 90 were overweight with a BMI of 25 to 29 kg/m, and 27 were obese with a BMI of 30 kg/m (30-41) or greater. Statistical analysis showed significantly longer ventilation times in the obese group, whereas all other variables were similar. Survival, major adverse cardiac and cerebrovascular event-free survival, valve competency, and freedom from reoperation were also comparable. CONCLUSIONS: Our data suggest that obesity should not deter a surgeon from selecting a minimally invasive approach. Despite longer postoperative ventilation times, a BMI of 30 kg/m or greater does not influence short- and medium-term outcome. Obese patients may even benefit from this approach because it avoids the need for sternotomy and therefore reduces the risk for sternal wound infection.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Cardiovascular Surgery
04 Faculty of Medicine > Epidemiology, Biostatistics and Prevention Institute (EBPI)
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2013
Deposited On:16 Oct 2013 16:01
Last Modified:05 Apr 2016 17:02
Publisher:Lippincott, Williams & Wilkins
ISSN:1556-9845
Publisher DOI:https://doi.org/10.1097/IMI.0b013e3182a20e5a
PubMed ID:23989818

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