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<P>Background: Obesity has been shown to be an independent risk factor for adverse outcomes and prolonged hospitalization following conventional coronary artery bypass (CAB). For this reason and because of increased technical challenges, obesity has been considered a relative contraindication for minimally invasive bypass. The purpose of this study was to determine if in fact severe or morbid obesity is an independent risk factor for patients undergoing minimally invasive CAB. </P><P>Methods: Outcome data of 350 consecutive endoscopic, atraumatic CAB procedures performed at our institution over a 4-year period were reviewed with respect to patient body mass index (BMI). All operations consisted of thoracoscopic left or right internal mammary artery (IMA) harvesting followed by off-pump grafting of the left anterior descending (with/without diagonal coronary artery) or right coronary artery via a 4-cm thoracotomy. Patients were divided into 4 groups: small (BMI � 24 kg/m<SUP>2</SUP>), normal to mild obesity (24 kg/m<SUP>2</SUP> < BMI 34 kg/m<SUP>2</SUP>), severe obesity (34 kg/m<SUP>2</SUP> < BMI � 40 kg/m<SUP>2</SUP>), and morbid obesity (BMI >40 kg/m<SUP>2</SUP>). Results: Although the BMI >34 kg/m<SUP>2</SUP> groups had a higher incidence of hypertension, diabetes, and hypercholesterolemia, there was no statistical difference in operative risk between groups. Thirty-day mortality, conversion to sternotomy, transfusion rate, and wound, pulmonary, neurological, and myocardial complications were not significantly different between groups. The BMI >34 kg/m<SUP>2</SUP> patients required longer IMA harvest times and total operating times, but the intensive care unit length of stay was not significantly different between groups. Hospital length of stay was longer for the BMI � 24 kg/m<SUP>2</SUP> group than for the BMI 18 to 34 kg/m<SUP>2</SUP> group (P = .025). Conclusion: Despite increased technical difficulty caused by obesity, it is not an independent risk factor for patients undergoing minimally invasive CAB.</P>

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Objective: We evaluated the performance of a new temperature management system (Arctic Sune, Medivance, Inc.) in maintaining normothermia during off-pump coronary artery bypass (OPCAB). Patients and methods: Ninety-eight unselected patients were prospectively randomized to either a conventional temperature management method (consisting of a sterile forced-air warming blanket, warm intravenous fluids, and maintenance of a warm OR) or the new Arctic Sun system (two pads, Arctic Sun Energy Transfer Padse placed on the patient's back with temperature-controlled water flowing through the pads). Results: The mean age, body surface area, and total operating time were similar in both groups. Despite significantly lower room temperatures ðp , 0:001Þ in the Arctic Sun group, the system maintained higher bladder and nasopharygeal temperatures (p , 0:001 and p , 0:001, respectively). A core temperature of at least 36 8C was achieved in 97% of the Arctic Sun patients compared with 42% in the conventional group. Additionally, intra-operative blood loss for the Arctic Sun patients was significantly less ðp ¼ 0:01Þ. Conclusions: The Arctic Sun system significantly outperformed conventional techniques in achieving and maintaining normothermia during off-pump coronary artery bypass. q

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