Fiorentino Mariafrancesca, Mikus Elisa, Sangiorgi Diego, Tripodi Alberto, Calvi Simone, Tenti Elena, Costantino Antonino, Savini Carlo
Division of Cardiac Surgery, Cardio-Vascular Surgery Department, Maria Cecilia Hospital, GVM Care & Research, 48033 Cotignola, Italy.
Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, 40126 Bologna, Italy.
Medicina (Kaunas). 2025 May 16;61(5):903. doi: 10.3390/medicina61050903.
This study examines the impact of Body Mass Index (BMI) on outcomes after mitral valve surgery via right minithoracotomy, an approach that may reduce wound complications in obese patients. Between January 2010 and December 2024, 1773 adult patients underwent minimally invasive mitral valve surgery at our institution. They were categorized into three groups: normal weight (BMI < 25, = 942), overweight (BMI 25-30, = 661), and obese (BMI > 30, = 170). The three groups exhibited significant differences, with a higher prevalence of hypertension, dyslipidemia, and diabetes ( < 0.001) in overweight and obese patients. Further-more, they had a greater incidence of preoperative atrial fibrillation ( < 0.001), prior stroke ( = 0.023), chronic obstructive pulmonary disease ( = 0.002), and elevated preoperative creatinine levels ( < 0.001). and their euroscore II was significantly higher ( = 0.040). In-hospital mortality and major complications were similar across groups, except for drainage output in the first 24 h ( = 0.002) and ICU stay ( = 0.022), both resulting higher in the overweight and obese patients. We employed inverse probability of treatment weighting (IPTW) to create three well-matched groups. Following IPTW, postoperative outcomes remained comparable across groups. However, obese patients exhibited a higher incidence of postoperative atrial fibrillation ( = 0.037) and required pacemaker implantation more frequently ( < 0.001). Our findings suggest that obesity does not increase the risk of mortality or major adverse events after minimally in-vasive mitral valve surgery. This approach may offer a less invasive alternative for obese patients, potentially reducing the risk of wound complications associated with conventional surgery.
本研究通过右胸小切口二尖瓣手术，探讨体重指数（BMI）对手术结局的影响，该手术方式可能会减少肥胖患者的伤口并发症。2010年1月至2024年12月期间，1773例成年患者在我院接受了微创二尖瓣手术。他们被分为三组：正常体重（BMI<25，n=942）、超重（BMI 25-30，n=661）和肥胖（BMI>30，n=170）。三组之间存在显著差异，超重和肥胖患者的高血压、血脂异常和糖尿病患病率更高（P<0.001）。此外，他们术前房颤的发生率更高（P<0.001）、既往有中风史（P=0.023）、慢性阻塞性肺疾病（P=0.002）以及术前肌酐水平升高（P<0.001），且其欧洲心脏手术风险评估系统（EuroSCORE）II显著更高（P=0.040）。除了术后24小时引流量（P=0.002）和重症监护病房（ICU）停留时间（P=0.022）外，各组的院内死亡率和主要并发症相似，超重和肥胖患者的这两项指标均更高。我们采用治疗权重逆概率法（IPTW）创建了三个匹配良好的组。IPTW后，各组术后结局仍具有可比性。然而，肥胖患者术后房颤的发生率更高（P=0.037），且更频繁地需要植入起搏器（P<0.001）。我们的研究结果表明，肥胖不会增加微创二尖瓣手术后的死亡风险或主要不良事件风险。这种手术方式可能为肥胖患者提供一种侵入性较小的替代方案，有可能降低与传统手术相关的伤口并发症风险。
