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Obesity Should Not Deter a Surgeon From Selecting a Minimally Invasive Approach for Mitral Valve Surgery

Reser, Diana MD*; Sündermann, Simon MD*; Grünenfelder, Jürg MD*; Scherman, Jacques MD*; Seifert, Burkhardt PhD; Falk, Volkmar MD*; Jacobs, Stephan MD*

Innovations: Technology & Techniques in Cardiothoracic & Vascular Surgery: May/June 2013 - Volume 8 - Issue 3 - p 225–229
doi: 10.1097/IMI.0b013e3182a20e5a
Original Articles

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/m2 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/m2 (18–24), 90 were overweight with a BMI of 25 to 29 kg/m2, and 27 were obese with a BMI of 30 kg/m2 (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/m2 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.

From the *Department of Cardiovascular Surgery, University Hospital Zürich, Zürich, Switzerland; and †Division of Biostatistics, ISPM, University of Zürich, Zürich, Switzerland.

Accepted for publication June 3, 2013.

Disclosure: The authors declare no conflict of interest.

Address correspondence and reprint requests to Diana Reser, MD, Department of Cardiovascular Surgery, University Hospital Zürich, Rämistrasse 100, 8091 Zürich, Switzerland. E-mail:

©2013 by the International Society for Minimally Invasive Cardiothoracic Surgery