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Mauricio A. Villavicencio
Thoralf M. Sundt, III
Richard C. Daly
Joseph A. Dearani
Christopher G.A. McGregor
Charles J. Mullany
Thomas A. Orszulak
Francisco J. Puga
Hartzell V. Schaff
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Ann Thorac Surg 2007;83:1403-1411
© 2007 The Society of Thoracic Surgeons

Original Articles: Cardiovascular

Cardiac Surgery in Patients With Body Mass Index of 50 or Greater

Mauricio A. Villavicencio, MD, Thoralf M. Sundt, III, MD*, Richard C. Daly, MD, Joseph A. Dearani, MD, Christopher G.A. McGregor, MB, FRCS, Charles J. Mullany, MB, MS, Thomas A. Orszulak, MD, Francisco J. Puga, MD, Hartzell V. Schaff, MD

Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota

Accepted for publication October 30, 2006.

* Address correspondence to Dr Sundt, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (Email: sundt.thoralf{at}mayo.edu).

Background: The seemingly inexorable rise in obesity worldwide is creating a new set of challenges for healthcare providers. Demand for cardiac surgical intervention among patients at extreme levels of obesity (body mass index [BMI] ≥ 50) is increasing; however, the risks, benefits, and resources required to meet this need have not been established.

Methods: Between 1993 and 2004, 57 patients with a BMI of 50 or more underwent cardiac surgical procedures at our institution. The mean BMI was 54 ± 4, weight range was 124 to 226 kg. The mean age of the study group was 55 ± 12 years, and comorbidities included diabetes mellitus in 29 (51%), hypertension in 40 (70%), hyperlipidemia in 22 (39%), and obstructive sleep apnea in 16 (28%).

Results: The operative mortality was 7% (4 patients). Eleven patients (20%) required prolonged intubation (more than 24 hours), and mean intensive care unit stay was 5 ± 9 days. Wound complications requiring surgery occurred in 3 (5%). Survival at 1 and 5 years was 93% ± 4% and 76 ± 8%, respectively. By univariate analysis, age and endocarditis were associated with long-term mortality and major perioperative complications. As a dichotomous variable, BMI greater than 54 was a significant predictor of renal failure and prolonged mechanical ventilation.

Conclusions: Cardiac surgery in the patient with a BMI of 50 or greater is associated with significant resource utilization, including prolonged intensive care unit and hospital stay, with prolonged intubation and wound complications relatively common.






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