Mini-Sternotomy Aortic Valve Replacement in Morbid Obesity: Can The Little Offer the Greater?

Background: Obesity is linked to higher morbidity and death in cardiac surgery, and mini sternotomy is an established approach for aortic valve surgery (AVR). However, the use of this approach is still controversial in this group of patients. Objective: This study aimed to evaluate the potential benefits of this technique in this population. Patients and Methods: From June 2019 to June 2022, 40 morbid obese patients (body mass index ≥ 40) underwent isolated AVR surgery at the National Heart Institute. The surgical approach was median sternotomy (20 patients) and partial upper sternotomy (20 patients). Pre-, intra-, and post-operative data were gathered and analyzed. Results: Patients treated with mini sternotomy AVR had reduced post-operative ventilation time (p= 0.0001), less blood drainage (p= 0.0001), and a lower need for blood transfusion (p= 0.03). They also presented advantages in terms of shorter intensive care unit and hospital stay (p= 0.0001). However, the operative, cross-clamp, and bypass times were significantly longer (p= 0.0001) in the minimally invasive group, which can be dramatically reduced with the introduction of sutureless valves. Inotropic support, pacemaker requirement, cerebrovascular accidents, and wound infection were observed and compared between the two groups. Conclusion: Ministernotomy approach is safe for obese patients undergoing surgical AVR, offering them less biological insult and reduced incidence of postoperative complications.