Conclusions
In conclusion, at our academic medical center, patients with aortic
valve disease and comorbid obesity who underwent aortic valve
replacement experienced no different perioperative outcomes regardless
of obesity class. When the obesity paradox was first discovered in the
field of cardiac surgery, surprise was born from the assumption that
patients with the medical comorbidity of an obese BMI would fare worse
after a serious surgical intervention, as is cardiac surgery.
Concertedly is the assumption that increasing obesity class may
correlate with increasing perioperative risk, length of hospital stay,
cost of care, and even postoperative mortality rate. In harmony with the
obesity paradox, our findings again contradict such an assumption. Obese
patients with higher BMIs faced no worse outcomes than those with lower
BMIs after minimally invasive aortic valve replacement. Thus, the same
discussions to be had with any patient considering a surgical
intervention for heart valve disease, inclusive of shared
decision-making of the operative approach – minimally invasive or
conventional full sternotomy – should be afforded to obese patients
regardless of obesity class.
Acknowledgements: The authors would like to acknowledge Susette
Coyle and Marie Macor in the Department of Surgery, Division of Surgical
Sciences at Rutgers Robert Wood Johnson Medical School for their
critical assistance in maintenance of the academic medical center’s
cardiac surgery database.