{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T01:40:18Z","timestamp":1779932418895,"version":"3.53.1"},"reference-count":25,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2025,5,16]],"date-time":"2025-05-16T00:00:00Z","timestamp":1747353600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background: This study examines the impact of Body Mass Index (BMI) on outcomes after mitral valve surgery via right minithoracotomy, an approach that may reduce wound complications in obese patients. Methods: Between January 2010 and December 2024, 1773 adult patients underwent minimally invasive mitral valve surgery at our institution. They were categorized into three groups: normal weight (BMI &lt; 25, n = 942), overweight (BMI 25\u201330, n = 661), and obese (BMI &gt; 30, n = 170). Results: The three groups exhibited significant differences, with a higher prevalence of hypertension, dyslipidemia, and diabetes (p &lt; 0.001) in overweight and obese patients. Further-more, they had a greater incidence of preoperative atrial fibrillation (p &lt; 0.001), prior stroke (p = 0.023), chronic obstructive pulmonary disease (p = 0.002), and elevated preoperative creatinine levels (p &lt; 0.001). and their euroscore II was significantly higher (p = 0.040). In-hospital mortality and major complications were similar across groups, except for drainage output in the first 24 h (p = 0.002) and ICU stay (p = 0.022), both resulting higher in the overweight and obese patients. We employed inverse probability of treatment weighting (IPTW) to create three well-matched groups. Following IPTW, postoperative outcomes remained comparable across groups. However, obese patients exhibited a higher incidence of postoperative atrial fibrillation (p = 0.037) and required pacemaker implantation more frequently (p &lt; 0.001). Conclusions: Our findings suggest that obesity does not increase the risk of mortality or major adverse events after minimally in-vasive mitral valve surgery. This approach may offer a less invasive alternative for obese patients, potentially reducing the risk of wound complications associated with conventional surgery.<\/jats:p>","DOI":"10.3390\/medicina61050903","type":"journal-article","created":{"date-parts":[[2025,5,16]],"date-time":"2025-05-16T08:32:29Z","timestamp":1747384349000},"page":"903","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Does Body Mass Index Impact Outcomes in Patients Undergoing Minimally Invasive Mitral Valve Surgery?"],"prefix":"10.3390","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1396-4330","authenticated-orcid":false,"given":"Mariafrancesca","family":"Fiorentino","sequence":"first","affiliation":[{"name":"Division of Cardiac Surgery, Cardio-Vascular Surgery Department, Maria Cecilia Hospital, GVM Care & Research, 48033 Cotignola, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2892-8700","authenticated-orcid":false,"given":"Elisa","family":"Mikus","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Cardio-Vascular Surgery Department, Maria Cecilia Hospital, GVM Care & Research, 48033 Cotignola, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-6666-3480","authenticated-orcid":false,"given":"Diego","family":"Sangiorgi","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Cardio-Vascular Surgery Department, Maria Cecilia Hospital, GVM Care & Research, 48033 Cotignola, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Tripodi","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Cardio-Vascular Surgery Department, Maria Cecilia Hospital, GVM Care & Research, 48033 Cotignola, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone","family":"Calvi","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Cardio-Vascular Surgery Department, Maria Cecilia Hospital, GVM Care & Research, 48033 Cotignola, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6974-0849","authenticated-orcid":false,"given":"Elena","family":"Tenti","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Cardio-Vascular Surgery Department, Maria Cecilia Hospital, GVM Care & Research, 48033 Cotignola, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3449-6986","authenticated-orcid":false,"given":"Antonino","family":"Costantino","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Cardio-Vascular Surgery Department, Maria Cecilia Hospital, GVM Care & Research, 48033 Cotignola, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo","family":"Savini","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Cardio-Vascular Surgery Department, Maria Cecilia Hospital, GVM Care & Research, 48033 Cotignola, Italy"},{"name":"Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, 40126 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2211","DOI":"10.1056\/NEJMoa1000367","article-title":"Body-mass index and mortality among 1.46 million white adults","volume":"363","author":"Hartge","year":"2010","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Global BMI Mortality Collaboration, Di Angelantonio, E., Bhupathiraju, S.N., Wormser, D., Gao, P., Kaptoge, S., de Gonzalez, A.B., Cairns, B.J., Huxley, R., and Jackson, C.L. (2016). Body-mass index and all-cause mortality: Individual-participant-data meta-analysis of 239 prospective studies in four continents. Lancet, 388, 776\u2013786.","DOI":"10.1016\/S0140-6736(16)30175-1"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"GBD 2015 Obesity Collaborators, Afshin, A., Forouzanfar, M.H., Reitsma, M.B., Sur, P., Estep, K., Lee, A., Marczak, L., Mokdad, A.H., and Moradi-Lakeh, M. (2017). Health Effects of Overweight and Obesity in 195 Countries over 25 Years. N. Engl. J. Med., 377, 13\u201327.","DOI":"10.1056\/NEJMoa1614362"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"4063","DOI":"10.1093\/eurheartj\/ehae508","article-title":"Obesity and cardiovascular disease: An ESC clinical consensus statement","volume":"45","author":"Koskinas","year":"2024","journal-title":"Eur. Heart J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"850","DOI":"10.1161\/CIRCULATIONAHA.116.022840","article-title":"Body Mass Index and Mortality Among Adults Undergoing Cardiac Surgery: A Nationwide Study With a Systematic Review and Meta-Analysis","volume":"135","author":"Mariscalco","year":"2017","journal-title":"Circulation"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"864","DOI":"10.1161\/CIRCULATIONAHA.117.026856","article-title":"An Apparent Obesity Paradox in Cardiac Surgery","volume":"135","author":"Carnethon","year":"2017","journal-title":"Circulation"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Jiang, X., Xu, J., Zhen, S., and Zhu, Y. (2023). Obesity is associated with postoperative outcomes in patients undergoing cardiac surgery: A cohort study. BMC Anesthesiol., 23.","DOI":"10.1186\/s12871-022-01966-1"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.1378\/chest.110.5.1173","article-title":"Factors predisposing to median sternotomy complications. Deep vs superficial infection","volume":"110","author":"Zacharias","year":"1996","journal-title":"Chest"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"912","DOI":"10.1016\/j.athoracsur.2004.03.038","article-title":"Postoperative sternal dehiscence in obese patients: Incidence and prevention","volume":"78","author":"Molina","year":"2004","journal-title":"Ann. Thorac. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1186\/s13019-023-02229-x","article-title":"Minithoracotomy versus sternotomy in mitral valve surgery: Meta-analysis from recent matched and randomized studies","volume":"18","author":"Jegaden","year":"2023","journal-title":"J. Cardiothorac. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e35","DOI":"10.1161\/CIR.0000000000000932","article-title":"2020 ACC\/AHA Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"143","author":"Otto","year":"2021","journal-title":"Circulation"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e1159","DOI":"10.1161\/CIR.0000000000000503","article-title":"2017 AHA\/ACC Focused Update of the 2014 AHA\/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines","volume":"135","author":"Nishimura","year":"2017","journal-title":"Circulation"},{"key":"ref_13","first-page":"e521","article-title":"2014 AHA\/ACC Guideline for the Management of Patients with Valvular Heart Disease: A report of the American College of Cardiology\/American Heart Association Task Force on Practice Guidelines","volume":"129","author":"Nishimura","year":"2014","journal-title":"Circulation"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1093\/eurheartj\/ehab395","article-title":"2021 ESC\/EACTS Guidelines for the management of valvular heart disease: Developed by the Task Force for the management of valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)","volume":"43","author":"Vahanian","year":"2022","journal-title":"Eur. Heart J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"616","DOI":"10.1093\/ejcts\/ezx324","article-title":"2017 ESC\/EACTS Guidelines for the management of valvular heart disease","volume":"52","author":"Falk","year":"2017","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1093\/ejcts\/ezs455","article-title":"Guidelines on the management of valvular heart disease (version 2012): The Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)","volume":"42","author":"Vahanian","year":"2012","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_17","first-page":"310","article-title":"Minimally Invasive Versus Sternotomy for Mitral Surgery in the Elderly: A Systematic Review and Meta-Analysis","volume":"16","author":"Hage","year":"2021","journal-title":"Innovations"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1016\/j.athoracsur.2010.09.039","article-title":"Outcomes of minimally invasive valve surgery versus standard sternotomy in obese patients undergoing isolated valve surgery","volume":"91","author":"Santana","year":"2011","journal-title":"Ann. Thorac. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1093\/ejcts\/ezaa274","article-title":"Is obesity associated with poorer outcomes in patients undergoing minimally invasive mitral valve surgery?","volume":"59","author":"Aljanadi","year":"2021","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Ali-Hasan-Al-Saegh, S., Helms, F., Aburahma, K., Takemoto, S., De Manna, N.D., Amanov, L., Ius, F., Karsten, J., Zubarevich, A., and Schmack, B. (2024). Can Obesity Serve as a Barrier to Minimally Invasive Mitral Valve Surgery? Overcoming the Limitations-A Multivariate Logistic Regression Analysis. J. Clin. Med., 13.","DOI":"10.3390\/jcm13216355"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/j.ijcard.2016.05.002","article-title":"Obesity and postoperative atrial fibrillation in patients undergoing cardiac surgery: Systematic review and meta-analysis","volume":"217","author":"Phan","year":"2016","journal-title":"Int. J. Cardiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1104","DOI":"10.1016\/j.athoracsur.2013.04.029","article-title":"Association between obesity and postoperative atrial fibrillation in patients undergoing cardiac operations: A systematic review and meta-analysis","volume":"96","author":"Hernandez","year":"2013","journal-title":"Ann. Thorac. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1016\/j.pcad.2022.12.006","article-title":"Effect of BMI on patients undergoing transcatheter aortic valve implantation: A systematic review and meta-analysis","volume":"78","author":"Gupta","year":"2023","journal-title":"Prog. Cardiovasc. Dis."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"898","DOI":"10.1161\/CIRCULATIONAHA.106.171016","article-title":"Obesity and cardiovascular disease: Pathophysiology, evaluation, and effect of weight loss: An update of the 1997 American Heart Association Scientific Statement on Obesity and Heart Disease from the Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism","volume":"113","author":"Poirier","year":"2006","journal-title":"Circulation"},{"key":"ref_25","first-page":"e5142","article-title":"Association Between Body Mass Index and Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement (TAVR) with Edwards SAPIENTM 3 TAVR Valves: A Single-Center Experience","volume":"11","author":"Ahmad","year":"2019","journal-title":"Cureus"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/5\/903\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:33:57Z","timestamp":1760031237000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/5\/903"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,16]]},"references-count":25,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,5]]}},"alternative-id":["medicina61050903"],"URL":"https:\/\/doi.org\/10.3390\/medicina61050903","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,16]]}}}