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Does obesity affect operative times and perioperative outcome of patients undergoing totally endoscopic coronary artery bypass surgery?

^a Innsbruck Medical University, Innsbruck, Austria
^b University of Maryland, Baltimore, USA

*Corresponding author. Department of Cardiac Surgery, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria, Tel.: +43 512 504 80786; fax: +43 512 504 22528.

E-mail address: dominik.wiedemann{at}i-med.ac.at (D. Wiedemann).

More and more patients undergoing coronary artery bypass grafting (CABG) are overweight. This patient group suffers from wound healing problems more often than normal-weight patients. Therefore, avoiding sternotomy in obese patients by using an endoscopic technique could be a promising approach. Robotic technology enables totally endoscopic coronary artery bypass grafting (TECAB) procedures. We investigated whether the intra-operative-times or perioperative-outcome after TECAB-procedure are negatively affected by obesity. Patients [n=127, 101 male, 26 female, median age 59 (31–77) years], undergoing arrested-heart TECAB procedure were enrolled. The median body mass index (BMI) in this patient cohort was 26 (19–38). In detail, 27 patients were normal-weight (BMI25 kg/m²), 67 patients were overweight (BMI 25.1–30 kg/m²), 29 patients were obese (BMI 30.1–33.9 kg/m²) and four patients were morbidly obese (BMI34 kg/m²). There was no correlation between BMI (1) left internal mammary artery (LIMA) takedown-time [Spearman-rank correlation coefficient (R)=0.02; P=n.s.], (2) lipectomy and pericardiotomy-time (R=0.042, P=n.s.), (3) total operative-time (R=–0.083: P=n.s.), (4) cardiopulmonary-bypass-time (R=–0.012; P=n.s.), (5) aortic-endoocclusion-time (R=–0.055; P=n.s.), (6) mechanical-ventilation-time (R=0.001, P=n.s.), (7) length of ICU-stay (R=0.04; P=n.s.), (8) length of hospital-stay (R=–0.103; P=n.s.) or (9) occurrence of intra- and/or postoperative adverse events. In overweight, obese but also morbidly obese patients the TECAB procedure did not increase operative times or the rate of intra- or postoperative complications. This patient group, therefore, benefits from this less traumatic version of coronary surgery.

Key Words: Obesity–coronary artery disease; Coronary artery bypass grafting; Endoscopic surgery; Robotic surgery