Objectives

Obesity may challenge surgeons performing fully-endoscopic mitral valve surgery (EMS) and affect clinical outcomes. Therefore, the aim of this study is to evaluate the outcome of pre-obese and obese patients undergoing EMS at our center.

Methods                                                                                                                      

From 2015 –2021, 605 patients underwent EMS including cases with concomitant atrial ablation and/or left atrial appendage closure. Patients were stratified by normal-weight (group 1 = BMI 20-25; n=312); pre-obese (group 2 = BMI 25-30; n=226) and obese (group 3 = BMI >30; n=67). Baseline characteristics are presented in table 1. Group 1 was considered control group in a comparative analysis.

Results

Severe mitral regurgitation (MR) was the main indication in the overall cohort (97.8%). Mitral valve repair and replacement were performed in 92.7% and 7.3%, respectively. There were no differences in the rate of concomitant atrial ablation between groups (group 1 vs. 2: 18.9 vs. 20.6%, p=0.64; group 1 vs. 3: 18.9 vs 16%, p=0.36). Cardiopulmonary bypass time (CPBT) and cross clamp time (CCT) were significantly lower in group 1 compared to group 2 and 3 (CPBT: 162.8±45.1 vs. 183.2±60.9min, p=<0.001; 162.8±45.1 vs. 178.9±50.9, p=0.01) (CCT 97.6±34.6 vs. 109.1±39.2min, p<0.001; 97.6±34.6 vs. 107.4±36.8 min, p=0.04). ICU length of stay was also significantly longer in group 2 and 3 (2.1±1.7 vs. 2.8±4.0days, p=0.005; 2.1±1.7 vs. 3.2±4.9days, p=0.001. The overall rate of wound healing disorders was very low at 0.8% with no significant difference between groups. Stroke rate in the overall cohort was 0%. Rate of re-thoracotomy of group 1 showed no significant difference compared to group 2 and 3 (5.9 vs. 7.1%, p=0.68; 5.9 vs. 7.5%, p=0.58). Rates of mortality were low in all groups and showed no significant difference (0 vs. 0.9%, p=0.65; 0 vs. 1.5%, p=0.17).

Conclusion

EMS can be safely performed in pre-obese and obese patients with similarly favourable clinical and hemodynamic results despite prolonged cardiopulmonary bypass and aortic cross-clamp times and duration of ICU stay.

Table 1.)