ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Cardiovascular Surgery
This article is part of the Research TopicRedefining Cardiovascular Care: Innovations and Challenges in Minimally Invasive and Transcatheter InterventionsView all 3 articles
Minimally Invasive Aortic Valve Replacement in Morbidly Obese Patients: Outcomes From a Cohort Study and Pooled Data Analysis
Provisionally accepted
Lukman Amanov1
Sadeq Ali-Hasan-Al-Saegh1*
Arian Arjomandi Rad2
Antonia Annegret Jauken1
Thanos Athanasiou2Jawad Salman1
Fabio Ius1Stefan Rümke1Bastian Schmack1Arjang Ruhparwar1Alina Zubarevich1Alexander Weymann1- 1Medizinische Hochschule Hannover Klinik fur Herz Thorax Transplantations und Gefasschirurgie, Hanover, Germany
- 2University of Oxford Radcliffe Department of Medicine, Oxford, United Kingdom
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Background: In the context of cardiac surgery, morbid obesity poses several perioperative challenges. Some surgeons consider obesity a relative contraindication for minimally invasive aortic valve replacement (MIAVR) due to anatomical and technical complexities. Although MIAVR is increasingly used in standard-risk populations, evidence supporting its safety and efficacy in morbidly obese patients remains limited. Methods: This retrospective cohort consisted of 920 patients who underwent MIAVR via partial upper ministernotomy at a high-volume cardiac surgery center between 2010 and May 2025. Patients were categorized into three groups based on BMI: Class I obesity (BMI 30–35 kg/m²; n=164), Class II–III obesity (BMI >35 kg/m²; n=54), and a non-obese control group (n=702). Key clinical outcomes, echocardiographic parameters, postoperative complications, and long-term mortality rates were compared. Additionally, a pairwise meta-analysis was conducted, incorporating five studies to assess outcomes of MIAVR versus conventional full sternotomy in obese individuals. Results: There were no significant differences in most of postoperative outcomes. However, higher rates of pneumothorax and arrhythmias were observed in Class II–III obesity. Multivariate regression did not identify obesity as an independent predictor of adverse outcomes. Meta-analysis confirmed comparable operative times and a trend toward shorter ICU stays and lower respiratory complications in the MIAVR group. Conclusion: This study argues that (i) obesity alone should not delay, deter, or preclude appropriate candidates from being referred for surgical aortic valve replacement, and (ii) partial upper ministernotomy should be considered the preferred access route in obese patients, as it consistently facilitates recovery without compromising safety.
Keywords: aortic valve replacement, Minimally invasive cardiac surgery, Ministernotomy, Body Mass Index, Obesity
Received: 04 Jul 2025; Accepted: 04 Dec 2025.
Copyright: © 2025 Amanov, Ali-Hasan-Al-Saegh, Rad, Jauken, Athanasiou, Salman, Ius, Rümke, Schmack, Ruhparwar, Zubarevich and Weymann. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Sadeq Ali-Hasan-Al-Saegh
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