Sarcopenia is an objective marker of poor outcome following cardiac surgery through median sternotomy. However, the clinical impact of sarcopenia after minimally invasive cardiac surgery (MICS) has not been well established. This study aimed to analyze the influence of sarcopenia on the early and late outcomes following MICS. We retrospectively examined 1248 patients who underwent MICS via right mini-thoracotomy or upper sternotomy between February 2009 and April 2020. Patients older than 65 years who underwent preoperative computed tomography were enrolled. Sarcopenia was defined as the lowest sex-specific quartile of the body surface area adjusted psoas muscle area. The early operative and late survival outcomes were compared, and the predictor of late composite outcome was analyzed using Cox proportional regression model. Early and late composite outcomes in both groups were also compared. A total of 367 patients were classified into the sarcopenia (n = 92) or non-sarcopenia (n = 275) group. Patients in the sarcopenia group were older, and had lower preoperative hemoglobin and albumin levels. They had higher estimated surgical mortality, but similar early mortality and major morbidity. The survival and late composite outcome were comparable between the two groups. Sarcopenia was neither an independent predictor of late death nor a composite outcome in the multivariable model. After MICS, patients with sarcopenia displayed comparable perioperative outcomes and survival. The clinical impact of sarcopenia on postoperative outcomes might be alleviated by MICS and early recovery protocol after MICS. MICS could be a reasonable approach for elderly patients with sarcopenia.

肌肉减少症是通过正中胸骨切开术进行心脏手术后不良结果的客观标志。然而，微创心脏手术 (MICS) 后肌肉减少症的临床影响尚未确定。本研究旨在分析肌肉减少症对 MICS 后早期和晚期结果的影响。我们回顾性检查了 2009 年 2 月至 2020 年 4 月期间通过右侧小切口开胸术或上胸骨切开术接受 MICS 的 1248 名患者。纳入了接受术前计算机断层扫描的 65 岁以上患者。肌肉减少症被定义为体表面积调整腰大肌面积的最低性别特异性四分位数。比较早期手术和晚期生存结果，并使用 Cox 比例回归模型分析晚期复合结果的预测因子。还比较了两组的早期和晚期综合结果。共有 367 名患者被分为肌肉减少症 (n = 92) 或非肌肉减少症 (n = 275) 组。肌肉减少症组的患者年龄较大，术前血红蛋白和白蛋白水平较低。他们的估计手术死亡率较高，但早期死亡率和主要发病率相似。两组之间的生存率和晚期综合结果具有可比性。肌肉减少症既不是晚期死亡的独立预测因子，也不是多变量模型中的复合结果。MICS 后，肌肉减少症患者显示出可比的围手术期结果和生存率。MICS 和 MICS 后的早期恢复方案可能会减轻肌肉减少症对术后结果的临床影响。