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.