Minimally invasive cardiac surgery

Is obesity associated with poorer outcomes in patients undergoing minimally invasive mitral valve surgery?

OBJECTIVES

METHODS

This is a retrospective cohort study of all patients undergoing MIMVS ± concomitant procedures over an 8-year period. Patients were stratified into 2 groups: BMI ≥ 30 kg/m2 and BMI ˂ 30 kg/m2, as per World Health Organization definitions. Baseline characteristics, operative and postoperative outcomes and 5-year survival were compared.

RESULTS

We identified 296 patients (BMI ≥30, n = 41, median 35.3, range 30–43.6; BMI <30, n = 255, median 26.2, range 17.6–29.9). The groups were well matched with regard to baseline characteristics. There was only 1 in-hospital mortality, and this was in the BMI < 30 group. There was no difference in repair rate for degenerative disease (100% vs 96.3%, P > 0.99 respectively) or operative durations [cross-clamp: 122 min interquartile range (IQR) 100–141) vs 125 min (IQR 105–146), P = 0.72, respectively]. There were only 6 conversions to sternotomy, all in non-obese patients. There was no significant difference in any other perioperative or post-operative outcomes. Using the Kaplan–Meier analysis, there was no significant difference in 5-year survival between the 2 groups (95.8% vs 95.5%, P = 0.83, respectively).

CONCLUSIONS

In patients having MIMVS, there is insufficient evidence to suggest that obesity affects either short- or mid-term outcomes. Obesity should therefore not be considered as a contraindication to this technique for experienced teams.

The incremental predictive value of frailty measures in elderly patients undergoing cardiac surgery: A systematic review

Emerging evidence demonstrates that frailty measures can predict adverse outcomes after cardiac procedures. Our objectives were to examine whether the inclusion of frailty measures adds incremental predictive value to existing surgical risk prediction models in patients undergoing cardiac surgery and to evaluate the reporting and methods of studies that investigated the prediction of frailty measures in cardiology. The inclusion of frailty measures adds incremental predictive value on existing perioperative risk-scoring systems. We systematically searched the EMBASE, MEDLINE, and Web of Science databases for relevant studies. Studies were included according to predefined inclusion criteria. The quality of included studies was appraised using the QUADAS-2 tool. Data were extracted and synthesized according to predefined methods. Twelve studies were included in the analysis. Included studies demonstrated the incremental predictive value of frailty measures on existing surgical risk models for mortality, but the predictive value of frailty measures alone was not consistent across literature. Few studies that investigated the predictive ability of frailty measures reported all important model performance measures. When comparing the predictive value of frailty measures with existing models, few studies reported if the frailty measurement was separately performed from the existing perioperative risk assessment. The addition of frailty measures to the existing perioperative risk models improved the prediction performance for mortality, but the incorporation of frailty assessment into perioperative risk assessment requires further evidence before making health policy recommendations.