Robotic mitral valve operations can be safely performed in obese patients

Abstract

Introduction Robotic cardiac surgery offers mitigated risks for obese patients requiring mitral valve surgery. We aimed to study the safety of robotic mitral surgery in the obese patient population by analyzing the outcomes of mitral surgery patients in our center for robotic cardiac surgery. Method This study retrospectively included 123 consecutive patients who underwent robotic mitral valve operations in a single center for robotic cardiac surgery. Patients with body mass index (BMI) ≥ 30 were compared against patients with BMI < 30 for demographic and operative parameters as well as postoperative outcomes. Results Mean BMI was 33.9 ± 2.8 in the obesity group (n = 87) and 25.4 ± 2.7 in the no‐obesity group (n = 36). Female gender (80.6% vs. 52.9%, p = .004), diabetes (25.0% vs. 10.3%, p = .036), and hypertension (48.6% vs. 26.4%, p = .018) were more common in patients with obesity. The obesity group was operated with similar cardiopulmonary bypass and total operative times with the no‐obesity group. Postoperative drainage and blood transfusion requirements were similar between the groups. Mechanical ventilation times (6.1 ± 2.2 vs. 8.0 ± 4.4 h, p = .003) and intensive care unit stay (20.4 ± 1.6 vs. 29.4 ± 3.7, p = .027) were shorter in the obesity group. Other postoperative outcomes of infection, atrial fibrillation, hospital stay duration, and readmission rates were similar between the groups. Conclusion Robotic mitral surgery is safe to perform in obese patients. Obesity should not be a contraindication for robotic mitral surgery as obese patients have outcomes similar to nonobese patients despite increased challenges and risk‐factors.

Subvalvular techniques enhanced with endoscopic robotic mitral valve repair

“…Although it is well known that patients with obesity are at increased risk for postoperative complications, 6 there is recent evidence to suggest that patients with a high body mass index have similar outcomes when undergoing robotic cardiac surgery. 7 The clinical preoperative variables did not differ significantly between the cohorts over time, and although the complexity of techniques increased, there was no impact on morbidity or mortality ( Table 1 ). Complex subvalvular procedures included papillary muscle trunk repositioning (5.1%; 51/1024), division of secondary anterior chordae (56.7%; 581/1024), septal myomectomy (5.4%; 55/1024), and resection of abnormal LV muscle bands (8.3%; 83/1024).…”

Robotic mitral valve replacement; results from the world’s largest series

“…Keeping in mind that the risk profile of our patients has dramatically increased in the last decade, the efforts for preventing any kind of operative complication should be accepted as a must. This percutaneous approach is especially beneficial in obese patients and enables a safe peripheral cannulation ( 5 , 6 ).…”

A Systematic Review and Meta-Analysis of Robot-Assisted Mitral Valve Repair

“…Many studies support the safety of this innovative approach. [24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] In addition to confirming the safety of robot-assisted MV surgery, some of these studies have demonstrated that ROB can be used in patients with previous sternotomies, 25 those with a high body mass index, 27 the elderly, 28 those with complex valvular pathologies, 29 and in concomitant procedures. 30,34 Indeed, there is also evidence that ROB can be undertaken in lower volume 24 and nonacademic centers without compromising outcomes.…”