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.