Minimally Invasive Direct Coronary Artery Bypass Grafting (MIDCAB) in Morbidly Obese Patients: Is It Still a Contraindication?

Objectives: Morbid obesity (defined as BMI ≥40 kg/m²) is known to complicate anesthesia and surgery with lethal and non-lethal events. Specifically after coronary artery bypass grafting (CABG), morbid obesity is a strong risk factor for mediastinitis and death. Morbid obesity has been considered as a relative contraindication for minimally invasive direct coronary artery bypass grafting (MIDCAB). However, MIDCAB in morbidly obese patients might avoid the occurrence of sternal instability and mediastinitis after CABG. The aim of this study was to investigate early and late outcomes in morbidly obese patients who received MIDCAB in our center.

Methods: Between January 2007 and May 2020, a total of 6,749 patients underwent isolated coronary artery bypass grafting (CABG) in our center. Among them, 119 patients were morbidly obese. Among the 119 morbidly obese patients 15 (12.6%) received MIDCAB and the rest 104 patients received CABG through sternotomy. We performed propensity score matching, chi-square analysis, and Kaplan–Meier estimate for long-term survival.

Result: In the unadjusted population, 10/104 (9.6%) patients who received CABG through sternotomy died within 30 days of surgery, while no patient died after MIDCAB. 1:2 matching revealed 15 patients with MIDCAB versus 25 patients with sternotomy CABG .Both groups were homogenous except for the number of grafts which was higher in sternotomy patients (median: 2 [2–3]) compared with MIDCAB patients (median: 1 [1–2]). 4/25 (16%) patients who received sternotomy died within 30 days of surgery. Surgical site infection occurred in 3/25 patients with sternotomy compared with 3/20 in the patients with MIDCAB. Postoperative stroke occurred in 2/25 patients with sternotomy, while no patient in MIDCAB group had postoperative stroke. Kaplan–Meier survival were similar in both groups (adjusted HR: 2.655, CI: 0.563–12.532, log-rank: 0.192).

Conclusion: MIDCAB is feasible in morbidly obese patients. MIDCAB is a safe alternative for sternotomy CABG with comparable incidences of postoperative stroke and 30-day mortality, but avoiding sternotomy and consequently deep sternal wound infection.

Publication History

Article published online:
19 February 2021