Key result
Obesity is not linked to higher in-hospital mortality following minimally invasive mitral valve surgery.
Why the study?
Some surgeons consider obesity a relative contraindication for minimally invasive mitral valve surgery, prompting an evaluation of whether obesity increases surgical complexity and worsens clinical outcomes.
Does obesity increase mortality or complications in patients undergoing minimally invasive mitral valve surgery?
Cohort (n=934)
No
Does obesity increase mortality or complications in patients undergoing minimally invasive mitral valve surgery?
Obesity is not associated with increased early or late mortality in patients undergoing minimally invasive mitral valve surgery, suggesting it should not be considered a contraindication despite a higher risk of postoperative complications.
Answers are grounded in this paper and cite their sources.
Obesity may not raise mortality risk after minimally invasive mitral valve surgery; hypothesis-generating and should not yet change practice.
Background/Objectives: Over the past two decades, significant advancements in mitral valve surgery have focused on minimally invasive techniques. Some surgeons consider obesity as a relative contraindication for minimally invasive mitral valve surgery (MIMVS). The aim of this study is to evaluate whether the specific characteristics of obese patients contribute to increased surgical complexity and whether this, in turn, leads to worse clinical outcomes compared to non-obese patients. Furthermore, we aim to explore whether these findings could substantiate the consideration of limiting this treatment option for obese patients. We investigated the outcomes of MIMVS in obese and non-obese patients at a high-volume center in Germany staffed by an experienced surgical team well-versed in perioperative management. Methods: A total of 934 MIMVS were performed in our high-volume center in Germany from 2011 to 2023. Of these, 196 patients had a BMI of 30 or higher (obese group), while 738 patients had a BMI below 30 (non-obese group), all of whom underwent MIMVS by right minithoracotomy. Demographic information, echocardiographic assessments, surgical data, and clinical outcome parameters were collected for all patients. Results: There was no significant difference in in-hospital, 30-day, and late mortality between groups (obese vs. non-obese: 6 [3.0%] vs. 14 [1.8%], p = 0.40; 6 [3.0%] vs. 14 [1.8%], p = 0.40; 13 [6.6%] vs. 39 [5.3%], p = 0.48, respectively). Respiratory insufficiency and arrhythmia occurred more frequently in the obese group (obese vs. non-obese: 25 [12.7%] vs. 35 [4.7%], p < 0.001; 35 [17.8%] vs. 77 [10.4%], p = 0.006). Conclusions: Obesity was not associated with increased early or late mortality in patients undergoing MIMVS. However, obese patients experienced higher incidences of postoperative complications, including respiratory insufficiency, arrhythmias, delirium, and wound dehiscence. Nonetheless, a multivariate logistic regression analysis indicated that obesity itself does not contraindicate MIMVS and should not be viewed as a barrier to offering this minimally invasive approach to obese patients.
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Ali‐Hasan‐Al‐Saegh et al. (2024) conducted a cohort in Mitral valve disease requiring surgery (n=934). Obesity (BMI ≥ 30) vs. Non-obese (BMI < 30) was evaluated on In-hospital mortality (p=0.40). Obesity was not associated with increased in-hospital mortality compared to non-obese patients undergoing minimally invasive mitral valve surgery.
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