Introduction
First described in congestive heart failure and chronic kidney disease patients, reverse epidemiology and the obesity paradox suggest an unexpected protective effect of overweight and obese body mass indices (BMIs) on patient outcomes.1,2 This paradoxical effect has been replicated in multiple studies since the early 2000’s, notably by Mariscalco and colleagues who studied over 900,000 patients to find an association between obesity and lower postoperative risk after cardiac surgery.3 Owing to the demonstration of the obesity paradox predominantly in observational studies, its value within clinical practice continues to be debated.
With the rise of minimally invasive heart valve surgery, both minithoracotomy and partial sternotomy have been demonstrated to be safe and feasible in patients with obesity.4,5 Minimally invasive valve surgery offers these patients an enhanced recovery experience with fewer postoperative complications as compared to the conventional full sternotomy.6,7
It is as of yet unknown how the feasibility and outcomes of minimally invasive valve surgery vary across the range of obese BMIs.6,7 The purpose of this study was to assess the outcomes of minimally invasive aortic valve replacement between patients of different obesity classes. We therein consider the operationalization of obesity class in operative planning, as a means of providing optimal, individualized patient care.