Impact of Body Mass Index in outcome of Surgery of Valvular Heart Diseases

Abstract

Objective: To determine the role of body mass index (BMI)in clinical outcomes after valve surgery. Study Design: Retrospective study. Place and Duration of Study: Department of cardiac Surgery, Shalimar Hospital, Shalimar Medical and Dental College, Lahore from 1stJuly 2018 to 30th June 2020. Methodology: A total of one hundred and fifty-nine (n =159) patients who had valve surgery were categorized into two groups based on their body mass index (BMI).Group A comprised forty-six patients with a body mass index below 18.5, while in Group B, one hundred and twelve patients were included with a BMI greater than 18.5.As it was a retrospective study the data for analysis were retrieved from the medical and perfusion records, post operative charts and operation theatre registers. All patients over 16 years of age and undergone the first surgical procedure were included. Informed consent was obtained from all the patients. The primary outcome of the study was to evaluate the mortality benefits between the two groups and the other outcomes were the difference in postoperative complications. Results: Patients in Group A; 60% were NYHA Class III & IV, mean pulmonary artery pressure was 59, atrial fibrillation was present in 48% and preoperative inotropes were needed in 15 % as compared to 10% in Group B. Majority of patient had rheumatic valvular heart disease in both groups (66% Vs 67%). The most common valve surgery done was isolated mitral valve replacement (MVR) in both groups (40% Vs 48%). Aortic cross-clamp was higher in Group A (73.4 min) and time for cardiopulmonary bypass were significantly longer in group B (91.2 min). Overall, in-hospital mortality was significant in Group A 10.6%, as compared to group B 5.4% (P=0.001). Moreover, total hospital stays (14.6 days Vs 9.8 days. P=0.003), blood transfusions (60% Vs 45%, P=0.002), complications (45% Vs 21%, P=0.0001) and readmissions (15% Vs 4.5%, P=0.01) were significantly higher in Group A in comparison to Group B. Conclusion: Patients with low body mass index have higher mortality and complication when compared with higher body mass index. These patients require risk stratification, intensive preoperative testing, and optimization of Nutritional status preoperatively. Key words: Body mass index (BMI), Valvular heart disease, Valve surgery