Frontiers in cardiovascular medicine · 2026
Impact of body mass index on outcomes in acute type A aortic dissection.
СтатьяНазвание и аннотация: Перевод в очереди
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Kiridly Adam H, Pupovac Stevan S, Dell'Aquila Michele, Arnone Paley, Jarral Omar A, Tejada Branden, Mason Ian, Kalimi Robert, Scheinerman S Jacob, Hartman Alan R, Brinster Derek R
Аннотация
BACKGROUND: Elevated body mass index (BMI) is associated with adverse outcomes after cardiac surgery, but its impact in acute type A aortic dissection (ATAAD) surgery is unclear. We assessed the relationship between BMI and outcomes after ATAAD repair.
METHODS: An institutional retrospective cohort review was undertaken of all consecutive patients who underwent repair of ATAAD between July 2014 and December 2022 (n = 398). Patients were stratified by BMI into three groups: 'non-obese' [BMI < 30 kg/m2; median 26.0 (23.0, 27.7) kg/m2] (n = 248), 'Obesity Class I' [30 ≤ BMI < 35 kg/m2; median 31.9 (30.8, 33.4) kg/m2] (n = 81), and 'Obesity Class II+' [BMI ≥ 35 kg/m2; median 38.9 (36.4, 41.9) kg/m2] (n = 69). Multivariable logistic regression was utilized to assess the relationship between BMI and 30-day mortality, stroke, and duration of ventilation.
RESULTS: Thirty-day operative mortality for the entire cohort was 12.8% (n = 51). The Obesity Class I cohort was associated with decreased odds of 30-day mortality [OR = 0.18, 95% CI: (0.06-0.62), p = 0.006] compared to the non-obese cohort, whereas the Obesity Class II + was not. Diabetes [OR = 2.9, 95% CI: (1.32-6.41), p = 0.008], history of lower extremity ischemia [OR = 4.27, 95% CI: (2.11-8.62), p < 0.001], age [OR = 1.04, 95% CI: (1.01-1.07), p = 0.005], duration of cardiopulmonary bypass [OR = 1.005, 95% CI: (1.00-1.01), p = 0.027], and units of intraoperative red blood cells received [OR = 1.08, 95% CI: (1.01-1.16), p = 0.028] were associated with increased 30-day mortality. There was no significant association between BMI groups and post-operative stroke or duration of ventilation.
CONCLUSION: The obesity paradox in cardiac surgery remains incompletely understood. In this cohort, BMI was not associated with increased 30-day mortality following ATAAD repair, with class I obesity demonstrating lower adjusted mortality. These findings support the continued practice of expeditious surgical intervention for ATAAD regardless of BMI.
METHODS: An institutional retrospective cohort review was undertaken of all consecutive patients who underwent repair of ATAAD between July 2014 and December 2022 (n = 398). Patients were stratified by BMI into three groups: 'non-obese' [BMI < 30 kg/m2; median 26.0 (23.0, 27.7) kg/m2] (n = 248), 'Obesity Class I' [30 ≤ BMI < 35 kg/m2; median 31.9 (30.8, 33.4) kg/m2] (n = 81), and 'Obesity Class II+' [BMI ≥ 35 kg/m2; median 38.9 (36.4, 41.9) kg/m2] (n = 69). Multivariable logistic regression was utilized to assess the relationship between BMI and 30-day mortality, stroke, and duration of ventilation.
RESULTS: Thirty-day operative mortality for the entire cohort was 12.8% (n = 51). The Obesity Class I cohort was associated with decreased odds of 30-day mortality [OR = 0.18, 95% CI: (0.06-0.62), p = 0.006] compared to the non-obese cohort, whereas the Obesity Class II + was not. Diabetes [OR = 2.9, 95% CI: (1.32-6.41), p = 0.008], history of lower extremity ischemia [OR = 4.27, 95% CI: (2.11-8.62), p < 0.001], age [OR = 1.04, 95% CI: (1.01-1.07), p = 0.005], duration of cardiopulmonary bypass [OR = 1.005, 95% CI: (1.00-1.01), p = 0.027], and units of intraoperative red blood cells received [OR = 1.08, 95% CI: (1.01-1.16), p = 0.028] were associated with increased 30-day mortality. There was no significant association between BMI groups and post-operative stroke or duration of ventilation.
CONCLUSION: The obesity paradox in cardiac surgery remains incompletely understood. In this cohort, BMI was not associated with increased 30-day mortality following ATAAD repair, with class I obesity demonstrating lower adjusted mortality. These findings support the continued practice of expeditious surgical intervention for ATAAD regardless of BMI.