Surgical outcomes associated with partial upper sternotomy in obese aortic disease patients

Background: Excellent partial upper sternotomy (PUS) outcomes have been reported for patients with aortic surgery, but whether this approach is particularly beneficial to obese patients remains to be established. This study was to explore the outcomes of aortic surgery conducted via a PUS or a full median sternotomy (FMS) approach in obese patients. Methods: Records for 493 patients that had undergone aortic surgery were retrospectively reviewed, leading to the identification of 158 consecutive obese patients and 335 non-obese patients. PUS and FMS group outcomes were compared within and between these two body mass index (BMI) groups. Results: In total, 88 and 70 obese patients compared to 180 and 155 non-obese patients underwent FMS and PUS, respectively. There were no differences between the FMS and PUS groups within either BMI cohort with respect to preoperative baseline indicators and postoperative complications. Among non-obese individuals, the PUS approach was linked to reduced ventilation time (P = 0.003), shorter intensive care unit (ICU) stay (P = 0.017), shorter hospital duration (P = 0.001), and decreased transfusion requirements (Packed red blood cells: P < 0.001; Fresh frozen plasma: P < 0.001). Comparable findings were also evident among obese patients. Conclusions: Obese aortic disease patients exhibited beneficial outcomes similar to those achieved for non-obese patients via a PUS approach which was associated with significant reductions in length of ICU residency, duration of hospitalization, ventilator use, and transfusion requirements. This surgical approach should be offered to aortic patients irrespective of their BMI.