title: Obesity should not deter a surgeon from selecting a minimally invasive approach for mitral valve surgery.
abstract: OBJECTIVE
  Obesity is highly prevalent in modern patient populations. Several studies have published conflicting outcomes after minimally invasive surgery with regard to morbidity and mortality. Some instances consider obesity as a relative contraindication for this approach because of inadequate exposure of the surgical field. Our aim was to investigate the outcomes of minimally invasive mitral valve surgery through a right lateral minithoracotomy in patients with a body mass index (BMI) of 30 kg/m2 or greater.
  
  
  METHODS
  We conducted a retrospective database review between January 1, 2009, and December 31, 2011. Preoperative, intraoperative, postoperative, and follow-up data of 225 consecutive patients were collected.
  
  
  RESULTS
  The patients were stratified according to their BMI: 108 had a normal weight with a BMI of lower than 25 kg/m2 (18-24), 90 were overweight with a BMI of 25 to 29 kg/m2, and 27 were obese with a BMI of 30 kg/m2 (30-41) or greater. Statistical analysis showed significantly longer ventilation times in the obese group, whereas all other variables were similar. Survival, major adverse cardiac and cerebrovascular event-free survival, valve competency, and freedom from reoperation were also comparable.
  
  
  CONCLUSIONS
  Our data suggest that obesity should not deter a surgeon from selecting a minimally invasive approach. Despite longer postoperative ventilation times, a BMI of 30 kg/m2 or greater does not influence short- and medium-term outcome. Obese patients may even benefit from this approach because it avoids the need for sternotomy and therefore reduces the risk for sternal wound infection.
authors.affiliation: Department of Cardiovascular Surgery, University Hospital Zürich, Zürich, Switzerland. diana.reser@usz.ch
authors.forename: Diana
authors.initials: D
authors.lastname: Reser
authors.forename: Simon
authors.initials: S
authors.lastname: Sündermann
authors.forename: Jürg
authors.initials: J
authors.lastname: Grünenfelder
authors.forename: Jacques
authors.initials: J
authors.lastname: Scherman
authors.forename: Burkhardt
authors.initials: B
authors.lastname: Seifert
authors.forename: Volkmar
authors.initials: V
authors.lastname: Falk
authors.forename: Stephan
authors.initials: S
authors.lastname: Jacobs
mesh_terms: D015992:Body Mass Index; D000075202:Contraindications; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D008943:Mitral Valve / Q000601:surgery*; D009765:Obesity / Q000150:complications*; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies