Is obesity associated with poorer outcomes in patients undergoing minimally invasive mitral valve surgery?

Abstract OBJECTIVES High body mass index (BMI) makes minimally invasive mitral valve surgery (MIMVS) more challenging with some surgeons considering this a contraindication. We sought to determine whether this is because the outcomes are genuinely worse than those of non-obese patients. METHODS This is a retrospective cohort study of all patients undergoing MIMVS ± concomitant procedures over an 8-year period. Patients were stratified into 2 groups: BMI ≥ 30 kg/m2 and BMI ˂ 30 kg/m2, as per World Health Organization definitions. Baseline characteristics, operative and postoperative outcomes and 5-year survival were compared. RESULTS We identified 296 patients (BMI ≥30, n = 41, median 35.3, range 30–43.6; BMI <30, n = 255, median 26.2, range 17.6–29.9). The groups were well matched with regard to baseline characteristics. There was only 1 in-hospital mortality, and this was in the BMI < 30 group. There was no difference in repair rate for degenerative disease (100% vs 96.3%, P > 0.99 respectively) or operative durations [cross-clamp: 122 min interquartile range (IQR) 100–141) vs 125 min (IQR 105–146), P = 0.72, respectively]. There were only 6 conversions to sternotomy, all in non-obese patients. There was no significant difference in any other perioperative or post-operative outcomes. Using the Kaplan–Meier analysis, there was no significant difference in 5-year survival between the 2 groups (95.8% vs 95.5%, P = 0.83, respectively). CONCLUSIONS In patients having MIMVS, there is insufficient evidence to suggest that obesity affects either short- or mid-term outcomes. Obesity should therefore not be considered as a contraindication to this technique for experienced teams.

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Does a high body mass index affect the outcomes of minimally invasive mitral valve surgery?

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0031-1297596 ◽

2012 ◽

Vol 60 (S 01) ◽

Author(s):

S Jacobs ◽

D Reser ◽

V Falk

Keyword(s):

Body Mass Index ◽

Mitral Valve ◽

Minimally Invasive ◽

Body Mass ◽

High Body Mass Index ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

High Body

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Mini-thoracotomy versus Full Sternotomy Techniques in Mitral Valve Surgery: Blood Loss, Wound infections, Post-operative Recovery, Morbidity and Mortality Investigation

American Journal of Surgical Research and Reviews ◽

10.28933/ajsrr-2021-04-0806 ◽

2021 ◽

pp. 21

Author(s):

Keyword(s):

Mitral Valve ◽

Blood Loss ◽

Minimally Invasive ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Wound Infections ◽

Operative Outcomes ◽

Group I ◽

Group Ii ◽

Operative Recovery

Background: Mitral valve surgery is routinely performed through a Median full sternotomy (MFS) with excellent long term outcomes. Minimally invasive mitral (MIMVS) valve surgery is also a surgical approach that improves operative outcomes. In this study we report early post-operative outcomes in minimally invasive mitral valve surgery compared with MFS access with reference to Blood Loss, Wound infections, post-operative Recovery, Morbidity, Mortality and others variables. Patient and Methods: This study was a prospective data collection from 52 consecutive patients who underwent isolated mitral valve surgery at our institution from November 2017 to October 2019. Population study was divided to two groups, MIMVS (group I n= 26) and MFS (group II n=26). Pre-operative planning were performed so that to obtain similar characteristics. Intra and post-operative data were analysed. Results: The baselines characteristics were similar in both groups. Of the 26 patients in group I, 23 (88.46%) underwent mitral valve replacement and 3 a mitral valve repair. All the patients in group II underwent mitral valve replacement. There was no difference in term of mortality and morbidity. MIMVS was associated with longer CPB time (mean 161.9 vs 89.8 mins, P =.025) but similar ACC (99 mins vs 64 P=.468) time. MIMVS Patients had likely lower incidence of red blood cells transfusion (12.2% vs 34.7%,), post-operative haemoglobin was similar before transfusion. Haemorrhage complications were more likely in the group II (26.08 vs 7.7%); requiring inotropic support was found to be higher in the group II (54.5 vs 19%). In addition, patients in the MIMVS group had a shorter mechanical ventilation time (1.6 [1-6] vs 3.6 [2-8] hours; P <.01), shorter ICU stay 1.36 [1-6] vs 3.6 [2-8] days, p<.01. Length of hospital stay and chest tube stay were found to be shorter, respectively 6.9 [6-16] vs 7, 7 [7-13] and (1.38 [1-2] days vs 2.64 [2-4], P <.01). Wound infections were not found in both groups. Conclusion: Although the controversy interest of minimally invasive mitral valve surgery, it may be associated with less blood loss, faster post-operative recovery but increases operation time.

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Design and training effects of a physical reality simulator for minimally invasive mitral valve surgery

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivz112 ◽

2019 ◽

Vol 29 (3) ◽

pp. 409-415 ◽

Cited By ~ 1

Author(s):

Ahmad-Fawad Jebran ◽

Shekhar Saha ◽

Narges Waezi ◽

Ammar Al-Ahmad ◽

Heidi Niehaus ◽

...

Keyword(s):

Mitral Valve ◽

Minimally Invasive ◽

Mitral Valve Surgery ◽

Learning Curves ◽

Valve Surgery ◽

Training Effects ◽

Training Course ◽

Skill Scores ◽

Significant Difference

Abstract OBJECTIVES Minimally invasive mitral valve surgery (MIMVS) through an endoscopic right minithoracotomy is a well-established yet complex procedure that has a challenging learning curve. We have developed a simulator for MIMVS and evaluated its short- and long-term training effects. METHODS Trainees without simulator experience or training in MIMVS were divided into 2 groups (10 students and 10 residents) and participated in a 5-day training course after initial instruction. Each trainee performed a ring annuloplasty. Scores were given by a supervisor who assessed 5 skills. The duration of each procedure was also measured. To evaluate the long-term effect of the training course, trainees performed the same procedure 4 weeks after the last session. RESULTS Trainees in the resident group were significantly older compared to those in the student group and had a mean surgical experience of 4.4 ± 0.78 years standard error of the mean. All other demographic data were similar. Significant learning curves could be achieved in both groups over the course of 5 days with regard to total skill scores and total duration. However, when we compared the learning curves of both groups, no significant difference could be seen. Long-term performance in both groups was still significantly better compared to that in the first training session. CONCLUSIONS Training with our simulator provided a significant enhancement of a trainee’s performance. This learning effect was achieved in both groups and was still evident 4 weeks later. We strongly recommend our simulator for simulation-based surgical education of cardiac surgeons interested in MIMVS.

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Minimally Invasive versus Conventional Mitral Valve Surgery Comparison of Early Outcomes

QJM ◽

10.1093/qjmed/hcaa042.005 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

M A Mohamed ◽

T M Elsayegh ◽

H Y Elbawab ◽

Y M Elnahas ◽

A H Omar

Keyword(s):

Mitral Valve ◽

Minimally Invasive ◽

Median Sternotomy ◽

Operation Time ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Safe Alternative ◽

Invasive Group ◽

Significant Difference ◽

The Right

Abstract The mitral valve has been traditionally approached through a median sternotomy. However, mitral valve surgery could be performed using smaller incisions including the right minithoracotomy. This study was a case-control non randomized conducted on 60 patients. All patients had isolated mitral valve disease for mitral valve surgery, 30 of them were operated through right anterolateral minithoracotomy and the others through full median sternotomy to study the effects of minimally invasive mitral valve surgery through right anterolateral minithoracotomy on morbidity and mortality compared with conventional mitral surgery. Medico legal concent was taken from all the patients in this study. All the patients completed the study and there was no mortality among the patients. There was no statistically significant difference as regards the demograohic data, NYHA score and the preoperative echocardiographic findings. Regarding intraoperative comparison, there was statistically significant difference in the cross-clamp time, total bypass time & total operation time. This difference may be due to the new experiences in this MIMVS and the lack of instrumentation that narrow the field of MIMVS. The length of the incision was highly significantly lesser in the minimally invasive group than the full sternotomy group. There was significant difference in the intensive care parameters. The blood loss and the blood transfusion required were lesser in the minimally invasive group. But the ventilation hours and ICU stay was nearly the same in both groups. There was highly significantly less postoperative pain in the minimally invasive group than in the stenotomy group. Total hospital stay was nearly the same in both groups. Minimally invasive mitral valve surgery is a safe alternative to a conventional approach and is associated with less morbidity especially with expert surgeon in simple mitral valve surgery.

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Clinical Results of Minimally Invasive Mitral Valve Surgery

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0b013e3181c490e5 ◽

2009 ◽

Vol 4 (6) ◽

pp. 311-318 ◽

Cited By ~ 9

Author(s):

Fabio Ius ◽

Enzo Mazzaro ◽

Vincenzo Tursi ◽

Giorgio Guzzi ◽

Enrico Spagna ◽

...

Keyword(s):

Mitral Valve ◽

Minimally Invasive ◽

Heart Association ◽

Clinical Results ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Actuarial Survival ◽

Significant Difference ◽

Group A ◽

Group B

Objective This study was carried out with the aim of presenting our experience with minimally invasive mitral surgery and compare the endoaortic clamp with the external aortic clamp (EAC) techniques. Methods Between December 2002 and May 2009, 139 patients (75 men, aged 63 ± 11 years) underwent video-assisted mitral valve surgery through right thoracotomy. Twelve (9%) patients were operated without clamping the aorta, 32 (23%) patients (group A) were operated on by using the endoaortic clamp, and 95 (68%) patients were operated on by using the EAC (group B). There was no significant difference between groups A and B regarding preoperative variables. Results Intraoperative procedure-associated problems were experienced in three group A patients (9.3%, two aortic dissections with conversion to sternotomy; one conversion due to bad exposure) and in two group B patients (2%, one conversion to sternotomy for bleeding and one for ascending aorta hematoma). At a mean follow-up of 32 months, 121 patients (97%) were in New York Heart Association class I–II, with satisfactory echocardiographic results. There was one in-hospital and six late deaths (three noncardiac, two cardiac, and one valve related). Five-year actuarial survival was 88% ± 8%. There were three reoperations, one early (<30 days) after complex mitral valve repair, with a 5-year freedom from reoperation of 97% ± 2%. Postoperative levels of myocardial cytonecrosis enzymes as well as the extracorporeal circulation time were significantly lower in group B patients (P < 0.05). Conclusions Intraoperative procedure-associated complications with endoclamping combined with an apparently better myocardial protection forced us to change our practice to the more simple and economic EAC technique.

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