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.

Publication History

Article published online:
11 February 2025