Minimally Invasive Aortic Valve Replacement Through Right Mini-Thoracotomy in Patients with Body Mass Index over 30

Background: Obese patients are at risk of complications after cardiac surgery through sternotomy. Right anterior mini-thoracotomy (RAMT) for aortic valve replacement (AVR) has shown excellent results in terms of mortality and morbidity. The aim of this study is to investigate safety and efficacy of minimally invasive AVR via RAMT in patients with body mass index (BMI) over 30.

Methods: Between March 2017 and February 2024, 336 patients with BMI of and over 30 mg/kg² underwent minimally invasive aortic valve replacement surgery via RAMT at three cardiac referral centers in Germany. Clinical data of the patients were retrospectively analyzed. Primary endpoint was 30-day mortality. Secondary endpoints were in-hospital mortality, operation-related morbidity such as Bleeding, wound healing disorders, re-exploration as well as operative times and duration of hospitalization.

Results: Median age was 67 (58–73) years old. 35.1% of patients were female gender. Operative success occurred in 99.7% of patients. Median aortic cross-clamping time was 58 (44–76) min. There was no postoperative intrathoracic bleeding and no patient had to undergo a rethoracotomy. 10.7% of the patients received transfusion of red cell blood units (RBC). Conversion to full sternotomy occurred in one (0.3%) patient. Median ICU stay and median hospital stay were 1 (1–2) days and 8 (7–12) days. Mean ventilation duration was 10.1 ± 21.4 hours. Respiratory insufficiency with need to reintubation was noted in 13 (3.9%) of patients. 30-day mortality and in-hospital mortality were 1.8% (6 patients) and 2.1% (7 patients), respectively. Two (0.6%) patients had wound infection and wound dehiscence.

Conclusion: Minimally invasive AVR via RAMT has been shown to be a safe and effective option for obese patients. Respiratory outcome was promising with shorter mechanical ventilation time and reduced need for post-extubation support. These advantages might be important for the obese patient to whom minimally invasive surgery should not be denied.

Publication History

Article published online:
11 February 2025