Does the Body Mass Index Affect the Mid-term Outcome Following Minimally Invasive Aortic Valve Surgery

Background: In obese patients, minimally invasive aortic valve replacement (MIS-AVR) may be challenging and the patient–prosthesis mismatch (PPM) risk increased. Aim of this retrospective single-center study was to evaluate the impact of body mass index (BMI) on the mid-term outcome following MIS-AVR.

Methods: Included were 307 patients who underwent MIS-AVR between01/2013 and 12/2015. The cohort was divided into normal/overweight (BMI < 30 kg/m²) vs. obese patients (BMI ≥ 30 kg/m²). Primary endpoints were 30-day and 2-year mortality and stroke. Secondary endpoints were type 3 bleeding, PPM, paravalvular leakage, wound healing disorder, and pacemaker rates.

Results: 191 patients presented with BMI < 30 kg/m² whereas 116 patients had a BMI ≥ 30 kg/m². The groups didn’t differ in baseline data, except a higher peripheral arterial disease rate (15.7 versus 26.7%; p = 0.01) in obese patients. Aortic clamp (75 ± 29 versus 87 ± 37 min; p = 0.001), cardiopulmonary bypass (104 ± 36 vs. 124 ± 56 min; p = 0.0002), and ventilation times (26 ± 6 versus 44 ± 8 h; p = 0.03) were longer in obese patients. They presented a higher risk for type 3 bleeding (2.6 vs. 9.5%; p = 0.008), but lower pacemaker rates (9 versus 3%; p = 0.02). PPM, paravalvular leakage and wound healing disorder rates showed no group differences. 30-day mortality (4.7 vs. 3.4%) and stroke rates (2 vs. 2.6%) as well as 2-year mortality (12.6 vs. 11.2%) and stroke rates (2.1 vs. 2.6%) showed no BMI-related differences.

Conclusion: MIS-AVR is—regardless of the patient’s BMI—a safe and reproducible therapy. Despite longer operation times and a higher risk for bleeding in obese patients, no influence of BMI on the postoperative morbidity, mortality, and stroke was seen.

 

MissingLinkText

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
11 February 2025