Obesity Does Not Affect Major Outcomes in Robotic Coronary Surgery

Authors

  • Emre Yasar Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Research and Training Hospital, 34303 Istanbul, Turkey
  • Zihni Mert Duman Department of Cardiovascular Surgery, Elazığ Fethi Sekin City Hospital, 23280 Elazığ, Turkey
  • Muhammed bayram Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Research and Training Hospital, 34303 Istanbul, Turkey
  • Mete Gürsoy Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Research and Training Hospital, 34303 Istanbul, Turkey
  • Ersin Kadiroğulları Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Research and Training Hospital, 34303 Istanbul, Turkey
  • Ünal Aydın Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Research and Training Hospital, 34303 Istanbul, Turkey

DOI:

https://doi.org/10.59958/hsf.6791

Keywords:

obesity, coronary artery bypass grafting, robotic-assisted surgery, minimally invasive surgery

Abstract

Background: Robotic-assisted coronary surgery is gaining attraction as an alternative to traditional open-heart procedures, offering potential benefits such as decreased mortality rates, shorter hospital stays, and reduced complications. This study aimed to investigate the outcomes of robotic-assisted coronary surgery, focusing particularly on the impact of obesity. Methods: A total of 210 consecutive patients underwent robotic-assisted coronary surgery over an eight-year period at a single institution. Patients were categorized based on body mass index (BMI), distinguishing between obese (BMI ≥30 kg/m2) and non-obese (BMI <30 kg/m2) groups. The analysis encompassed preoperative characteristics, operative factors, and postoperative outcomes. Results: Comparisons between obese and non-obese patients revealed similar preoperative comorbidities. However, the operation time was prolonged in the obese group (p = 0.03). Major cardiac and cerebrovascular events, along with overall complications, displayed no significant disparities between the groups. Notably, superficial wound infections were more prevalent among obese patients (p = 0.03). Importantly, intensive care unit and hospital stay times were comparable between the two groups. Conclusion: Robotic-assisted coronary surgery demonstrates its potential as a viable alternative to conventional open-heart procedures, offering benefits such as reduced mortality rates, shorter hospital stays, and minimized perioperative complications. This study's findings underscore the feasibility and safety of this approach, with outcomes comparable between obese and non-obese patients.

Author Biographies

Emre Yasar, Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Research and Training Hospital, 34303 Istanbul, Turkey

Cardiovascular Surgery Departement

Zihni Mert Duman, Department of Cardiovascular Surgery, Elazığ Fethi Sekin City Hospital, 23280 Elazığ, Turkey

Cardiovascular Surgery Department

Muhammed bayram, Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Research and Training Hospital, 34303 Istanbul, Turkey

Cardiovascular Surgery Department

Mete Gürsoy, Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Research and Training Hospital, 34303 Istanbul, Turkey

Cardiovascular Surgery

Ersin Kadiroğulları, Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Research and Training Hospital, 34303 Istanbul, Turkey

Cardiovascular Surgery Department

Ünal Aydın, Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Research and Training Hospital, 34303 Istanbul, Turkey

Cardiovascular Surgery Department

References

Mihaljevic T, Jarrett CM, Gillinov AM, Williams SJ, DeVilliers PA, Stewart WJ, et al. Robotic repair of posterior mitral valve prolapse versus conventional approaches: potential realized. The Journal of Thoracic and Cardiovascular Surgery. 2011; 141: 72–80.e4.

Chitwood WR, Jr, Rodriguez E, Chu MWA, Hassan A, Ferguson TB, Vos PW, et al. Robotic mitral valve repairs in 300 patients: a single-center experience. The Journal of Thoracic and Cardiovascular Surgery. 2008; 136: 436–441.

Folliguet T, Vanhuyse F, Constantino X, Realli M, Laborde F. Mitral valve repair robotic versus sternotomy. European Journal of Cardio-thoracic Surgery: Official Journal of the European Association for Cardio-thoracic Surgery. 2006; 29: 362–366.

Yanagawa F, Perez M, Bell T, Grim R, Martin J, Ahuja V. Critical Outcomes in Nonrobotic vs Robotic-Assisted Cardiac Surgery. JAMA Surgery. 2015; 150: 771–777.

Doulamis IP, Spartalis E, Machairas N, Schizas D, Patsouras D, Spartalis M, et al. The role of robotics in cardiac surgery: a systematic review. Journal of Robotic Surgery. 2019; 13: 41–52.

Reser D, Sündermann S, Grünenfelder J, Scherman J, Seifert B, Falk V, et al. Obesity should not deter a surgeon from selecting a minimally invasive approach for mitral valve surgery. Innovations (Philadelphia, Pa.). 2013; 8: 225–229.

Kitahara H, Patel B, McCrorey M, Nisivaco S, Balkhy HH. Morbid Obesity Does not Increase Morbidity or Mortality in Robotic Cardiac Surgery. Innovations (Philadelphia, Pa.). 2017; 12: 434–439.

Sen O, Aydin U, Kadirogullari E, Bayram M, Karacalilar M, Kutluk E, et al. Mid-Term Results of Peripheral Cannulation After Robotic Cardiac Surgery. Brazilian Journal of Cardiovascular Surgery. 2018; 33: 443–447.

Kahraman Karataş MZ, Onan B, Aydin Ü, Kadi̇roğullari E, Şen O, Ersoy B, et al. Percutaneous internal jugular vein cannulation in minimally invasive cardiac surgery. Damar Cerrahi Dergisi. 2018; 27: 124–129.

Yaşar E, Duman ZM, Bayram M, Kahraman MZ, Köseoğlu M, Kadiroğulları E, et al. Predictors and outcomes of conversion to sternotomy in minimally invasive coronary artery bypass grafting. Turk Gogus Kalp Damar Cerrahisi Dergisi. 2023; 31: 161–168.

Jaacks LM, Vandevijvere S, Pan A, McGowan CJ, Wallace C, Imamura F, et al. The obesity transition: stages of the global epidemic. The Lancet. Diabetes & Endocrinology. 2019; 7: 231–240.

Lavie CJ, Milani RV, Ventura HO. Obesity and cardiovascular disease: risk factor, paradox, and impact of weight loss. Journal of the American College of Cardiology. 2009; 53: 1925–1932.

Takagi H, Umemoto T. Overweight, but not obesity, paradox on mortality following coronary artery bypass grafting. Journal of Cardiology. 2016; 68: 215–221.

Benedetto U, Danese C, Codispoti M. Obesity paradox in coronary artery bypass grafting: myth or reality? The Journal of Thoracic and Cardiovascular Surgery. 2014; 147: 1517–1523.

Oreopoulos A, Padwal R, Norris CM, Mullen JC, Pretorius V, Kalantar-Zadeh K. Effect of obesity on short- and long-term mortality postcoronary revascularization: a meta-analysis. Obesity (Silver Spring, Md.). 2008; 16: 442–450.

Rubinshtein R, Halon DA, Jaffe R, Shahla J, Lewis BS. Relation between obesity and severity of coronary artery disease in patients undergoing coronary angiography. The American Journal of Cardiology. 2006; 97: 1277–1280.

Liu JJ, Liang L, Kong QY, Ma XL, Chi LQ, Lai YQ. A study on the perioperative effects of obesity on minimally invasive coronary artery bypass grafting and its surgical techniques. Interdisciplinary Cardiovascular and Thoracic Surgery. 2023; 36: ivad092.

Bonatti J, Schachner T, Bernecker O, Chevtchik O, Bonaros N, Ott H, et al. Robotic totally endoscopic coronary artery bypass: program development and learning curve issues. The Journal of Thoracic and Cardiovascular Surgery. 2004; 127: 504–510.

Oehlinger A, Bonaros N, Schachner T, Ruetzler E, Friedrich G, Laufer G, et al. Robotic endoscopic left internal mammary artery harvesting: what have we learned after 100 cases? The Annals of Thoracic Surgery. 2007; 83: 1030–1034.

Halkos ME, Liberman HA, Devireddy C, Walker P, Finn AV, Jaber W, et al. Early clinical and angiographic outcomes after robotic-assisted coronary artery bypass surgery. The Journal of Thoracic and Cardiovascular Surgery. 2014; 147: 179–185.

Currie ME, Romsa J, Fox SA, Vezina WC, Akincioglu C, Warrington JC, et al. Long-term angiographic follow-up of robotic-assisted coronary artery revascularization. The Annals of Thoracic Surgery. 2012; 93: 1426–1431.

Yang M, Wu Y, Wang G, Xiao C, Zhang H, Gao C. Robotic Total Arterial Off-Pump Coronary Artery Bypass Grafting: Seven-Year Single-Center Experience and Long-Term Follow-Up of Graft Patency. The Annals of Thoracic Surgery. 2015; 100: 1367–1373.

Wiedemann D, Schachner T, Bonaros N, Weidinger F, Kolbitsch C, Friedrich G, et al. Does obesity affect operative times and perioperative outcome of patients undergoing totally endoscopic coronary artery bypass surgery? Interactive Cardiovascular and Thoracic Surgery. 2009; 9: 214–217.

Vassiliades TA Jr, Nielsen JL, Lonquist JL. Effects of obesity on outcomes in endoscopically assisted coronary artery bypass operations. The Heart Surgery Forum. 2003; 6: 99–101.

Hemli JM, Darla LS, Panetta CR, Jennings J, Subramanian VA, Patel NC. Does body mass index affect outcomes in robotic-assisted coronary artery bypass procedures? Innovations (Philadelphia, Pa.). 2012; 7: 350–353.

Zukowska A, Zukowski M. Surgical Site Infection in Cardiac Surgery. Journal of Clinical Medicine. 2022; 11: 6991.

Lilienfeld DE, Vlahov D, Tenney JH, McLaughlin JS. Obesity and diabetes as risk factors for postoperative wound infections after cardiac surgery. American Journal of Infection Control. 1988; 16: 3–6.

Hysi I, Pinçon C, Guesnier L, Gautier L, Renaut C, Géronimi H, et al. Results of elective cardiac surgery in patients with severe obesity (body mass index≥35 kg/m2). Archives of Cardiovascular Diseases. 2014; 107: 540–545.

Published

2023-10-25

How to Cite

Yasar, E., Duman, Z. M., bayram, M. ., Gürsoy, M., Kadiroğulları, E., & Aydın, Ünal. (2023). Obesity Does Not Affect Major Outcomes in Robotic Coronary Surgery. The Heart Surgery Forum, 26(5), E525-E530. https://doi.org/10.59958/hsf.6791

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