Share this article on:

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 and Techniques in Cardiothoracic and 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