C39 TOTALLY ENDOSCOPIC VALVE SURGERY: FEASIBILITY AND ADVANTAGES IN OBESE PATIENTS

Abstract

Abstract Objective Obesity is a relative contraindication to Minimally Invasive Cardiac Surgery because of its technical challenges. Aim of the study is to evaluate if totally endoscopic approach is feasible in treating heart valve’s pathology in obese patients and if 30–days outcomes and complications are non–inferior to non–obese patients. Methods From January 2018 to June 2022, 1544 consecutive unselected patients underwent totally endoscopic heart valve treatment at our institution. Treated valves were aortic, mitral, tricuspid in various combination. Concomitant procedures and different etiology were included. Among them, 177 were obese people and 1367 were non–obese based on Body Mass Index (BMI). Main working port was obtained with limited skin incision: peri–areolar/sub–mammary for mitral and tricuspid treatment, right anterior mini–thoracotomy for aortic valve treatment. We used a 5 mm 30° endoscope and 2 additional 5 mm miniport for vent line and aortic clamp. Neo–chordae implantation plus annuloplasty ring was the preferred technique for mitral repair. Results Median BMI and 1°– 3° quartiles in non–obese group was 24 [22 – 26] and inferior to obese group 32 [30 – 33] (p < 0.01). In both group CPB and Cross Clamp median time was not statistically significant: 147 minutes [121 – 181] vs 150 minutes [126 – 195] (p = 0.69), 95 [77 – 120] vs 97 [79 – 122] (p = 0.39). Conversion to full sternotomy occurred in 14 cases (0.9%) in non–obese patients vs 2 cases (1.12%) in obese patients (p = 0.89). Oro–Tracheal intubation median time was 5 hours [4 – 7] in non obese versus 6 hours [4 – 8] in obese (p < 0.01). ICU median hours stay were 20 [16 – 40] vs 24 [18 – 48] respectively in non–obese and obese group (p < 0.01). Post–operative hospitalization median stay was 5 days [4 – 7] vs 6 days [4 – 8] in obese group (p = 0.06). Stroke occurred in 15 non–obese patients (0.9%) vs 3 obese patients (1.6%) (p = 0.42). Wound complications occurred in 9 non–obese patients (0.65%) vs 5 obese patients (2.8%) (p = 0.52). All cause of mortality was 18 (1.1%) in non–obese vs 6 (3.3%) in obese (p = 0.11). Conclusions Surgery was feasible in both groups with comparable CPB and Cross–Clamp time, no difference in surgical revision rate and sternotomic conversion. Obese patients had slightly longer OTI time and ICU stay. However hospitalization days, mortality, stroke and wound complications rate were not different. Totally endoscopic approach was essential to achieve these results.