Outcomes of minimally invasive valve surgery versus standard sternotomy in obese patients undergoing isolated valve surgery.
BACKGROUND
We hypothesize that composite in-hospital surgical complications are lower in obese patients who undergo minimally invasive valve surgery for aortic and (or) mitral valve disease, when compared with the standard median sternotomy approach.


METHODS
We retrospectively reviewed 2,288 heart operations done at our institution between January 3, 2005 and January 10, 2010, and identified 160 consecutive obese patients, defined as patients with a body mass index of greater than 30 kg/m(2), who underwent isolated mitral and (or) aortic valve surgery. The outcomes of those who had minimally invasive valve surgery were compared with a matched control group who had valve surgery through a median sternotomy approach.


RESULTS
Of the 160 patients, 64 underwent the minimally invasive approach and 96 had a median sternotomy. The mean age was 69.4 ± 11 years for the minimally invasive group, and 64.7 ± 11.5 for the median sternotomy group (p = 0.015). Composite postoperative complications occurred in 15 (23.49%) versus 49 (51.0%) patients (p = 0.034) in the minimally invasive group versus median sternotomy, respectively. The difference was driven by a lower incidence of acute renal failure (0 vs 6 patients [6.25%], p = 0.041), prolonged intubation (12 [18.7%] vs 33 [34.3%], p = 0.049), reintubation (3 [4.68%] vs 15 [15.6%], p = 0.032), deep wound infections (0 vs 4 [4.1%], p = 0.098), and death (0 vs 8 [8.3%], p = 0.041), respectively. All patients in the minimally invasive group were alive at 30 days.


CONCLUSIONS
Minimally invasive surgery for isolated valve lesions in obese patients has a lower morbidity and mortality when compared with the standard median sternotomy approach.
Columbia University Division of Cardiology, Miami Beach, Florida, USA. osantana@msmc.com
Orlando
O
Santana
Javier
J
Reyna
Robert
R
Grana
Mauricio
M
Buendia
Gervasio A
GA
Lamas
Joseph
J
Lamelas
D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D015897:Comorbidity; D005260:Female; D006333:Heart Failure / Q000453:epidemiology; D006349:Heart Valve Diseases / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods / Q000401:mortality*; D008943:Mitral Valve / Q000601:surgery*; D009765:Obesity / Q000453:epidemiology*; D011183:Postoperative Complications / Q000453:epidemiology*; D015995:Prevalence; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D056346:Sternotomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality