Cardiopulmonary bypass and deep hypothermic circulatory arrest in a massively obese patient

Abstract

As a consequence of the rising global prevalence and magnitude of obesity, a greater proportion of patients presenting for cardiac surgery is morbidly obese. Being overweight (body mass index; BMI 25-29.9 kg/m²) or obese (BMI 30-35 kg/m²) appears to confer some survival benefit following cardiac surgery. By contrast, morbid obesity (BMI >40 kg/m²) is associated with an increased likelihood of postoperative complications and prolonged intensive care unit and hospital length of stay. The physical difficulties encountered when managing this group of patients is exemplified by those undergoing complex, multiple procedures requiring prolonged cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest (DHCA). We present the successful management of a massively obese 19-year-old male (BMI 45 kg/m²) with Marfan’s syndrome who required aortic root and arch replacement under DHCA. The selection of extracorporeal circuit components to accommodate a large circulating volume and permit high CPB flow rates (>9 l/min) is discussed.

Keywords

*adverse effects aorta cardiac surgical procedures *complications diagnosis hypothermia induced Marfan syndrome methods morbid obesity *surgery surgery thoracic

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References

1 Villavicencio MA Sundt TM Daly RC . Cardiac surgery in patients with body mass index of 50 or greater. Ann Thorac Surg 2007; 83(4): 1403–1411.

2 Schwann TA Habib RH Zacharias A . Effects of body size on operative, intermediate, and long-term outcomes after coronary artery bypass operation. Ann Thorac Surg 2001; 71(2): 521–530.

3 Brandt M Harder K Walluscheck KP . Severe obesity does not adversely affect perioperative mortality and morbidity in coronary artery bypass surgery. Eur J Cardiothorac Surg 2001; 19(5): 662–666.

4 Drain AJ Gerrard C Ferguson JI Cafferty F Gurprashad R Vuylsteke A . Does body mass index (BMI) affect cost in cardiac surgery? 'A pound (pound) for pound (lb) analysis'. Interact Cardiovasc Thorac Surg 2006; 5(3): 282–284.