Influence of body mass index on outcomes after minimal-access aortic valve replacement through a J-shaped partial upper sternotomy. Issue 1 (December 2016)

• Record Type: Journal Article
• Authors: Acharya, Metesh; Harling, Leanne; Moscarelli, Marco; Ashrafian, Hutan; Athanasiou, Thanos; Casula, Roberto
• Is Part Of: Journal of cardiothoracic surgery. Volume 11:Issue 1(2016)
• Page Start: 1
• Page End: 7
• Publication Date: 2016-12
• Subjects: Aortic valve replacement -- Minimally invasive -- Minimal access -- Cardiac surgery; Chest -- Surgery -- Periodicals; Heart -- Surgery -- Periodicals; 617.54005
• DOI: 10.1186/s13019-016-0467-2
• Languages: English
• ISSNs: 1749-8090

Abstract

Abstract Background Minimal-access aortic valve replacement (MAAVR) may reduce post-operative blood loss and transfusion requirements, decrease post-operative pain, shorten length stay and enhance cosmesis. This may be particularly advantageous in overweight/obese patients, who are at increased risk of post-operative complications. Obese patients are however often denied MAAVR due to the perceived technical procedural difficulty. This retrospective analysis sought to determine the effect of BMI on post-operative outcomes in patients undergoing MAAVR. Methods Ninety isolated elective MAAVR procedures performed between May 2006–October 2013 were included. Intra- and post-operative data were prospectively collected. Ordinary least squares univariate linear regression analysis was performed to determine the effect of BMI as a continuous variable on post-operative outcomes. One-way ANOVA and Chi-squared testing was used to assess differences in outcomes between patients with BMI <25 (n = 36) and BMI ≥25 (n = 54) as appropriate. Results There was no peri-operative mortality, myocardial infarction or stroke. Univariate regression demonstrated longer cross-clamp times (p = 0.0218) and a trend towards increased bypass times (p = 0.0615) in patients with higher BMI. BMI ≥25 was associated with an increased incidence of hospital-acquired pneumonia (p = 0.020) and new-onset atrial fibrillation (p = 0.036) compared to BMI <25. However, raised BMI did not extend ICU (p = 0.3310) or overall hospital stay (p = 0.2614). Similar rates of sternal wound complications, inotrope requirements and renal dysfunction were observed in both normal- and overweight/obese-BMI groups. Furthermore, increasing BMI correlated with reduced mechanical ventilation time (p = 0.039) and early post-operative blood loss (p = 0.004). Conclusions Our results demonstrate that within the range of this study, MAAVR is a safe, reproducible and effective procedure, affording equivalent clinical outcomes in both overweight/obese and normal-weight patients considered for an isolated first-time AVR, with low post-operative morbidity and mortality. MAAVR should therefore be considered as an alternative surgical strategy to reduce obesity-related complications in patients requiring aortic valve replacement.