Minimally Invasive Mitral Valve Surgery In Obese Patients
Erik Cura Stura, Cristina Barbero, Claudia Calia, Marco Pocar, Stefano Salizzoni, Giovanni Marchetto, Mauro Rinaldi, Massimo Boffini.
AOU Cittą della Salute e della Scienza di Torino, TURIN, Italy.
Objective: Obesity is becoming a major health problem in the Western world. Results of mitral valve surgery through standard sternotomy in obese patients are controversial especially because of high risk of respiratory, infective and wound complications. Minimally invasive approach could be an advantage in this subgroup of high-risk patients. Methods: From January 2006 to January 2020, 1510 patients underwent minimally invasive mitral valve surgery in our department, of these 131 (8.7%) were obese patients (BMI≥30). Results: Male were 48%, mean age was 63.8±11.2 years, mean Logistic EuroSCORE was 10.8±15.4. Main comorbidities were: hypertension (72.5%), diabetes (29%), COPD (20.6%), chronic renal failure (19.8%), peripheral vasculopathy (7.6%), AF (42%) and pulmonary hypertension (14.5%). The mean EF was 55.2±11.3%. 30 (22.9%) patients had undergone previous cardiac surgery and 6.1% were urgencies. Mitral valve repair was performed in 42.7%, TV surgery (12.2%) and AF-cryoablation (13.7%) were associated procedures. Mean cardiopulmonary and cross clamp time were respectively 141±51 and 96±33 minutes. The most used aortic clamp technique was endoreturn (58%). Conversions to sternotomy were 3.8%. Operative mortality was 0.7%. Reoperation for bleeding occurred in 3.8% patients. Postoperatively, in 6.9% cases was necessary haemodialysis, in 5.4% PM implantation and in 2.3% tracheostomy. Neurological complications occurred in 2.3% patients. Groin wound infection/lymphocele occurred in 6 (4.6%) patients and in 5 (3.8%) surgical wound revision was necessary. Thoracic wound revision was performed in only one case. Mean and median intubation time, ICU and hospital stay were respectively 41±136 h (11h), 3.5±6.8 days (1.0 day) and 11.4±11.8 days (8.0 days). The 30-day mortality rate was 4.6%. Conclusions: Minimally invasive approach appears to be safe, feasible and reproducible permitting a good mitral valve exposure even in obese patients. It is associated with low post-operative complications, especially wound related.
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