The Influence of Severe Obesity on the Safety of Minimally Invasive Coronary Revascularization

Objective: Obesity is a well-established risk factor in surgical procedures; however, its impact on outcomes following Total Coronary Revascularization via Anterior Thoracotomy (TCRAT) remains uncertain. This study aimed to evaluate the influence of severe obesity on in-hospital outcomes in patients undergoing TCRAT.  

Methods: A retrospective analysis was conducted on 600 patients who underwent TCRAT between November 2019 and November 2024. Patients were stratified by body mass index (BMI) into normal weight, pre-obesity, and obesity classes, with Group A (BMI <35.0 kg/m²) and Group B (BMI >35.0 kg/m²) serving as primary comparison groups. Intraoperative parameters, including total operation time, aortic cross-clamp time, and cardiopulmonary bypass (CPB) time, were recorded. Postoperative outcomes, such as ICU length of stay, incidence of delirium, atrial fibrillation, pneumonia, and wound infection, were analyzed.  

Results: The cohort included 551 non-obese patients (mean age 67.5 ± 9.6 years; BMI 27.4 ± 3.6 kg/m²) and 49 patients with severe obesity (mean age 63.6 ± 7.6 years; BMI 37.8 ± 2.2 kg/m²). Obese patients had significantly longer total operation times (349.4 ± 80.6 min vs. 313.4 ± 74.1 min, p < 0.05), while aortic cross-clamp times (96.5 ± 27.1 min vs. 92.5 ± 33.1 min) and CPB times (161.9 ± 34.0 min vs. 151.2 ± 42.6 min) were comparable between groups. The average number of distal anastomoses per patient was similar (3.1 ± 0.7 in obese patients vs. 3.0 ± 0.8 in non-obese patients). Postoperative complications, including pneumonia and wound infections, did not differ significantly between groups. 

Conclusions: Severe obesity does not appear to negatively affect the safety or efficacy of TCRAT. Although operation times were longer in obese patients, complete anatomical revascularization was achieved in 100% of cases, with an average of 3.0 distal anastomoses per patient. The incidence of postoperative complications, including infections, was comparable between obese and non-obese patients. These findings indicate that obesity should not be considered a contraindication for TCRAT. With appropriate perioperative management, TCRAT represents a viable and effective minimally invasive surgical option for complete coronary revascularization in obese patients.