Effect of obesity in minimally invasive mitral valve surgery

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung Pub Date : 2026-07-01 Epub Date: 2026-02-13 DOI:10.1016/j.hrtlng.2026.102730

Cristina Barbero MD, PhD , Marco Pocar MD, PhD , Stefano Salizzoni MD, PhD , Dario Brenna MD , Valentina Aloi MD , Cecilia Capozza MD , Claudia Filippini PhD , Anna Chiara Trompeo MD , Mauro Rinaldi MD

{"title":"Effect of obesity in minimally invasive mitral valve surgery","authors":"Cristina Barbero MD, PhD , Marco Pocar MD, PhD , Stefano Salizzoni MD, PhD , Dario Brenna MD , Valentina Aloi MD , Cecilia Capozza MD , Claudia Filippini PhD , Anna Chiara Trompeo MD , Mauro Rinaldi MD","doi":"10.1016/j.hrtlng.2026.102730","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Obesity has tripled worldwide over the past 50 years. Existing evidence depicts conflicting relationships between body mass index and operative risk in cardiac surgery. Some large analyses have showed a shaped relationship between obesity and peri-operative mortality; others have found an inverse relationship, a so-called <em>obesity paradox</em>.</div></div><div><h3>Objectives</h3><div>We aimed to outline the effects of obesity on early outcome in minimally invasive mitral valve (MV) surgery.</div></div><div><h3>Methods</h3><div>One-thousand-seven-hundred-twenty consecutive patients who underwent mini-thoracotomy MV surgery at a single tertiary care academic centre since 2006 were retrospectively analysed. Multivariable logistic regression served to identify predictors of 30-day outcomes.</div></div><div><h3>Results</h3><div>Obesity (n=149/1695, 8.8%) was predictive of 30-day mortality (5.4% vs. 1.8%; p=0.010; odds ratio [OR] 3.14, 95% CI 1.36–7.27), but not when excluding patients with associated coronary and/or extracardiac arteriopathy (n=255/1695, 15%). Conversely, obesity was the sole predictor of death in this subgroup (4.3% vs. 1.9%; p=0.015; OR 3.65, 95% CI 1.01–13.17). Other predictors in the entire cohort were age, creatinine, reoperation and arteriopathy. Obese patients had more comorbidities and less degenerative MV prolapse, and parallel higher probability of MV replacement (p<0.001). Cardiopulmonary bypass time, but not cardioplegic arrest time, was longer (p=0.007). Morbidity, primarily driven by respiratory and wound complications, was also higher, with longer intensive care and hospital length-of-stay (p<0.001).</div></div><div><h3>Conclusions</h3><div>Obesity confers additional operative risk in MV surgery despite a minimally invasive approach. However, increased risk is confined to patients with concomitant arteriopathy and atherosclerotic burden, for whom weight loss is advisable in a nonurgent scenario.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"78 ","pages":"Article 102730"},"PeriodicalIF":2.6000,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Heart & Lung","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0147956326000075","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2026/2/13 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Obesity has tripled worldwide over the past 50 years. Existing evidence depicts conflicting relationships between body mass index and operative risk in cardiac surgery. Some large analyses have showed a shaped relationship between obesity and peri-operative mortality; others have found an inverse relationship, a so-called obesity paradox.

Objectives

We aimed to outline the effects of obesity on early outcome in minimally invasive mitral valve (MV) surgery.

Methods

One-thousand-seven-hundred-twenty consecutive patients who underwent mini-thoracotomy MV surgery at a single tertiary care academic centre since 2006 were retrospectively analysed. Multivariable logistic regression served to identify predictors of 30-day outcomes.

Results

Obesity (n=149/1695, 8.8%) was predictive of 30-day mortality (5.4% vs. 1.8%; p=0.010; odds ratio [OR] 3.14, 95% CI 1.36–7.27), but not when excluding patients with associated coronary and/or extracardiac arteriopathy (n=255/1695, 15%). Conversely, obesity was the sole predictor of death in this subgroup (4.3% vs. 1.9%; p=0.015; OR 3.65, 95% CI 1.01–13.17). Other predictors in the entire cohort were age, creatinine, reoperation and arteriopathy. Obese patients had more comorbidities and less degenerative MV prolapse, and parallel higher probability of MV replacement (p<0.001). Cardiopulmonary bypass time, but not cardioplegic arrest time, was longer (p=0.007). Morbidity, primarily driven by respiratory and wound complications, was also higher, with longer intensive care and hospital length-of-stay (p<0.001).

Conclusions

Obesity confers additional operative risk in MV surgery despite a minimally invasive approach. However, increased risk is confined to patients with concomitant arteriopathy and atherosclerotic burden, for whom weight loss is advisable in a nonurgent scenario.

查看原文本刊更多论文

肥胖对微创二尖瓣手术的影响

在过去的50年里，全世界的肥胖人数增加了两倍。现有证据表明，心脏手术中体重指数与手术风险之间存在矛盾关系。一些大型分析表明，肥胖与围手术期死亡率之间存在一定的关系；其他人则发现了相反的关系，即所谓的肥胖悖论。目的探讨肥胖对微创二尖瓣手术早期预后的影响。方法回顾性分析2006年以来在某三级医疗学术中心连续行小开胸MV手术的1720例患者。多变量逻辑回归用于确定30天预后的预测因子。结果肥胖（n=149/1695, 8.8%）可预测30天死亡率（5.4% vs. 1.8%; p=0.010；优势比[OR] 3.14, 95% CI 1.36-7.27），但当排除相关冠状动脉和/或心外动脉病变患者时则不然（n=255/1695, 15%）。相反，肥胖是该亚组中唯一的死亡预测因子（4.3% vs. 1.9%; p=0.015; OR 3.65, 95% CI 1.01-13.17）。整个队列的其他预测因素包括年龄、肌酐、再手术和动脉病变。肥胖患者的合并症较多，退行性中压脱垂较少，同时中压置换的概率较高（p<0.001）。体外循环时间较长，而心脏骤停时间较长（p=0.007）。发病率也较高，主要由呼吸和伤口并发症引起，重症监护时间和住院时间较长（p<0.001）。结论尽管采用微创入路，肥胖仍会增加中压手术的手术风险。然而，增加的风险仅限于伴有动脉病变和动脉粥样硬化负担的患者，对于这些患者，建议在非紧急情况下减肥。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Heart & Lung 医学-呼吸系统

CiteScore

4.60

自引率

3.60%

发文量

184

审稿时长

35 days

期刊介绍： Heart & Lung: The Journal of Cardiopulmonary and Acute Care, the official publication of The American Association of Heart Failure Nurses, presents original, peer-reviewed articles on techniques, advances, investigations, and observations related to the care of patients with acute and critical illness and patients with chronic cardiac or pulmonary disorders. The Journal''s acute care articles focus on the care of hospitalized patients, including those in the critical and acute care settings. Because most patients who are hospitalized in acute and critical care settings have chronic conditions, we are also interested in the chronically critically ill, the care of patients with chronic cardiopulmonary disorders, their rehabilitation, and disease prevention. The Journal''s heart failure articles focus on all aspects of the care of patients with this condition. Manuscripts that are relevant to populations across the human lifespan are welcome.