Does Body Mass Index Affect Outcomes in Different Minimally Invasive Mitral Valve Repair Approaches?
Presented During:
Thursday, May 4, 2023: 6:30PM - Saturday, May 6, 2023: 2:29AM
New York Hilton Midtown
Posted Room Name:
Grand Ballroom Foyer
Abstract No:
MP015
Submission Type:
Abstract Submission
Authors:
Andrea Amabile (1), Alyssa Morrison (2), Ziad Hassan (3), Syed Usman Bin Mahmood (4), Irbaz Hameed (5), Sigurdur Ragnarsson (4), Ritu Agarwal (2), Weiguo Ma (6), Michael LaLonde (7), Markus Krane (8), Arnar Geirsson (6)
Institutions:
(1) Yale School of Medicine, New Haven, CT, (2) Yale, New Haven, CT, (3) Yale, new haven, CT, (4) N/A, N/A, (5) Division of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, (6) Yale New Haven Hospital, New Haven, CT, (7) Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, (8) Division of Cardiac Surgery, Yale School of Medicine, New Haven, CT
Submitting Author:
Andrea Amabile
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Yale School of Medicine
Yale School of Medicine
Co-Author(s):
Alyssa Morrison
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Yale
Yale
Ziad Hassan
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Yale
Yale
Syed Usman Bin Mahmood
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N/A
N/A
Irbaz Hameed
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Division of Cardiac Surgery, Department of Surgery, Yale University School of Medicine
Division of Cardiac Surgery, Department of Surgery, Yale University School of Medicine
Sigurdur Ragnarsson
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N/A
N/A
Ritu Agarwal
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Yale
Yale
Weiguo Ma
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Yale New Haven Hospital
Yale New Haven Hospital
Michael LaLonde
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Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine
Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine
Markus Krane
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Division of Cardiac Surgery, Yale School of Medicine
Division of Cardiac Surgery, Yale School of Medicine
*Arnar Geirsson
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Yale New Haven Hospital
Yale New Haven Hospital
Presenting Author:
Andrea Amabile
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Yale School of Medicine
Yale School of Medicine
Abstract:
Objective: High body mass index (BMI) correlates with increased morbidity and mortality after cardiac surgery. We aimed to elucidate if any differences in outcomes existed in patients with high BMI undergoing mitral valve repair (MVr) with different minimally invasive approaches.
Methods: We performed a retrospective, cohort study of patients undergoing minimally invasive MVr at a quaternary academic center between 04/2011–04/2022. Information on demographics, comorbidities, intraoperative variables, and postoperative outcomes were retrieved. Patients were stratified by surgical approach: anterolateral mini-thoracotomy (n=62) versus totally endoscopic, robotic-assisted MVr (n=200). Emphasis was given to data on renown obesity-related complications (i.e., need for blood products, postoperative reintubation, prolonged ventilation, surgical site infection, acute kidney injury). A sub-analysis was performed in patients with BMI≥25 to probe if any outcomes differences existed between the two minimally invasive approaches in overweight and obese patients.
Results: We found no difference in median BMI values between the two groups (p=0.766), with 54.8% of patients in the mini-thoracotomy group and 47.0% of patients in the robotic group having a BMI≥25 (p=0.31). In the whole population, patients undergoing robotic versus mini-thoracotomy MVr had significantly shorter aortic cross-clamp times (79 vs. 97 minutes, p<0.001) and postoperative length of stay (4 vs. 5 days, p<0.001); these differences persisted in the sub-analysis of patients with high BMI (p=0.04 and p<0.001, respectively). Patients with high BMI undergoing either approach had remarkably low and not significantly different rates of surgical site infection (p=0.462), need for blood products (p=0.381), and acute kidney injury (p=1). Results are further detailed in Table 1. Interestingly, patients with high BMI who underwent robotic MVr had similar rates of pulmonary-related complications, regardless of a higher proportion of patients with chronic lung disease (17.0% versus 2.9%, p=0.04) and despite higher rate of extubation in the operating room (58.5% versus 8.8%, p<0.001) when compared to patients with high BMI in the mini-thoracotomy group, with no difference in reintubation rates (3.2% versus 2.9%, p=1).
Conclusions: The benefits of totally endoscopic, robotic-assisted MVr persist even in patients with high BMI, with lower aortic cross-clamp times and shorter postoperative length of stay.
Methods: We performed a retrospective, cohort study of patients undergoing minimally invasive MVr at a quaternary academic center between 04/2011–04/2022. Information on demographics, comorbidities, intraoperative variables, and postoperative outcomes were retrieved. Patients were stratified by surgical approach: anterolateral mini-thoracotomy (n=62) versus totally endoscopic, robotic-assisted MVr (n=200). Emphasis was given to data on renown obesity-related complications (i.e., need for blood products, postoperative reintubation, prolonged ventilation, surgical site infection, acute kidney injury). A sub-analysis was performed in patients with BMI≥25 to probe if any outcomes differences existed between the two minimally invasive approaches in overweight and obese patients.
Results: We found no difference in median BMI values between the two groups (p=0.766), with 54.8% of patients in the mini-thoracotomy group and 47.0% of patients in the robotic group having a BMI≥25 (p=0.31). In the whole population, patients undergoing robotic versus mini-thoracotomy MVr had significantly shorter aortic cross-clamp times (79 vs. 97 minutes, p<0.001) and postoperative length of stay (4 vs. 5 days, p<0.001); these differences persisted in the sub-analysis of patients with high BMI (p=0.04 and p<0.001, respectively). Patients with high BMI undergoing either approach had remarkably low and not significantly different rates of surgical site infection (p=0.462), need for blood products (p=0.381), and acute kidney injury (p=1). Results are further detailed in Table 1. Interestingly, patients with high BMI who underwent robotic MVr had similar rates of pulmonary-related complications, regardless of a higher proportion of patients with chronic lung disease (17.0% versus 2.9%, p=0.04) and despite higher rate of extubation in the operating room (58.5% versus 8.8%, p<0.001) when compared to patients with high BMI in the mini-thoracotomy group, with no difference in reintubation rates (3.2% versus 2.9%, p=1).
Conclusions: The benefits of totally endoscopic, robotic-assisted MVr persist even in patients with high BMI, with lower aortic cross-clamp times and shorter postoperative length of stay.
Mitral Conclave:
Minimally Invasive & Robotic Mitral Valve Repair
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