Mitral Valve Repair in Patients With Class I Obesity

Abstract

Background Obesity may increase the technical complexity of robotic mitral valve (MV) repair, but comparative outcomes with sternotomy remain poorly defined. Objectives This study aimed to compare perioperative and long-term outcomes of robotic vs sternotomy MV repair in patients with class I obesity. Methods A total of 880 patients with class I obesity (body mass index 30-34.9 kg/m2) underwent MV repair at our clinic between 2008 and 2025. After excluding those with mitral stenosis, active endocarditis, prior sternotomy, or concomitant procedures, 429 patients remained. Propensity score matching (1:1) yielded 132 patients in each group who underwent either robotic or conventional sternotomy MV repair. Results Median age was 59 years (IQR: 52-66), and 81% were male. Cardiopulmonary bypass and cross-clamp times were longer in the robotic group than in the sternotomy group (86 vs 65 minutes and 60 vs 48 minutes, respectively; P < 0.001). Robotic MV repair was associated with shorter hospitalization (3.5 vs 5 days; P < 0.001) and a lower postoperative transfusion rate (1.5% vs 10.6%; P = 0.002). There were no operative deaths in either group. No sternal wound infections occurred. Thirty-day readmission was numerically higher after robotic repair (12.8% vs 4.3%; P = 0.064). Ten-year survival was 92% (95% CI: 87% to 97%) with no significant difference between groups (P = 0.83). Conclusions In patients with class I obesity, the robotic approach in comparison to sternotomy was associated with lower transfusion rates, shorter hospitalization, and comparable operative mortality and long-term survival relative to sternotomy. Although 30-day readmission was numerically higher among robotic patients, most events were minor and managed without intervention.