MP15. Does Body Mass Index Affect Outcomes in Different Minimally Invasive Mitral Valve Repair Approaches?
Presented During: Moderated E-Posters
University of Pittsburgh Medical Center
PITTSBURGH, PA
United States - Contact Me
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Thursday, May 4, 2023: 6:30 PM - Saturday, May 6, 2023: 2:29 AM
New York Hilton Midtown
Room: Grand Ballroom Foyer
Description
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.