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

Abstract

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 (BMI <or= 25 kg/m(2)), 67 patients were overweight (BMI 25.1-30 kg/m(2)), 29 patients were obese (BMI 30.1-33.9 kg/m(2)) and four patients were morbidly obese (BMI >or= 34 kg/m(2)). 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.