Minimal Invasive Total Arterial Coronary Artery Bypass Grafting in Obese Patients

Background: Minimal Invasive Total Arterial Coronary Artery Bypass Grafting (MICS-CABG) is a promising surgical approach, which enables the operative treatment of coronary artery disease without median sternotomy and its complications. Obese patients with a body mass index (BMI) of 30 or higher have a higher risk for sternal wound infection and would benefit more from this approach. On the contrary, these patients are usually deprived from this approach because of presumed higher technical complexity. With growing expertise, we include all patients with isolated multivessel CAD without emergent indication for MICS-CABG. In our study, we therefore compared the perioperative and mid-term outcomes of MICSCABG in obese (BMI >30) versus nonobese (BMI<30) patients.

Methods: Between January 2015 and March 2023, a total of 241 patients underwent off-pump MICS-CABG via left intercostal thoracotomy in Heart Center Leipzig. Patients' data was collected prospectively and was retrospectively analyzed. For the sake of the analysis, patients were subdivided into 2 main subgroups: obese (n = 50) and nonobese (n = 191). Primary objectives were 30-day survival and perioperative myocardial infarction. Secondary objectives were mid-term survival and MACCE.

Results: The mean age was 66 years (±7) and most of the patients were males (n = 212). Median BMI was 26.0 (23.9–27.7) vs. 31.2 (30.8–32.3), p ≤ 0.001. Several preoperative risk factors such as Diabetes mellites pulmonary hypertension, COPD, and peripheral vascular disease were significantly higher in the obese subgroup (26% vs. 58%, p ≤ 0.001, 5.8% vs. 18%, p = 0.009, 7.3% vs. 22%, p = 0.002, 16% vs. 28%, p = 0.016 respectively) so as Euro Score II (1.70 (0.99–3.26) vs. 2.32 (1.27–3.72), p = 0.025). Length of surgery was longer in the nonobese group (250 ± 62.7 vs. 276.3 ± 63.8, p = 0.04) as they received in mean significantly greater number of distal anastomosis (2.36 vs. 2.29, p = 0.04). No intraoperative conversion to sternotomy in both groups was registered. The rate of thoracotomy for bleeding and perioperative myocardial were also similar in both groups. 30-day survival was 99.6% for the whole cohort. No difference regarding perioperative myocardial infarction was found between both arms of the study (7.3 vs. 4.0, p = 0.54). Mid-term data showed no difference in survival or MACCE rate between both groups (p = 0.87 and p = 0.83, respectively).

Conclusion: MICs-CABG is safe and feasible for obese and nonobese patients alike. Obesity should not be an exclusion criterion in high volume centers for MICs-CABG.

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Artikel online veröffentlicht:
13. Februar 2024