{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T05:04:18Z","timestamp":1789535058388,"version":"build-2803163510"},"reference-count":17,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      An institutional retrospective cohort review was undertaken of all consecutive patients who underwent repair of ATAAD between July 2014 and December 2022 (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009398). Patients were stratified by BMI into three groups: \u2018non-obese\u2019 [BMI &amp;lt; 30\u2005kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ; median 26.0 (23.0, 27.7) kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ] (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009248), \u2018Obesity Class I\u2019 [30\u2009\u2264\u2009BMI &amp;lt; 35\u2005kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ; median 31.9 (30.8, 33.4) kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ] (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200981), and \u2018Obesity Class II+\u2019 [BMI \u2265 35\u2005kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ; median 38.9 (36.4, 41.9) kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ] (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200969). Multivariable logistic regression was utilized to assess the relationship between BMI and 30-day mortality, stroke, and duration of ventilation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Thirty-day operative mortality for the entire cohort was 12.8% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200951). The Obesity Class I cohort was associated with decreased odds of 30-day mortality [OR\u2009=\u20090.18, 95% CI: (0.06\u20130.62),\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.006] compared to the non-obese cohort, whereas the Obesity Class II\u2009+\u2009was not. Diabetes [OR\u2009=\u20092.9, 95% CI: (1.32\u20136.41),\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.008], history of lower extremity ischemia [OR\u2009=\u20094.27, 95% CI: (2.11\u20138.62),\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001], age [OR\u2009=\u20091.04, 95% CI: (1.01\u20131.07),\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.005], duration of cardiopulmonary bypass [OR\u2009=\u20091.005, 95% CI: (1.00\u20131.01),\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.027], and units of intraoperative red blood cells received [OR\u2009=\u20091.08, 95% CI: (1.01\u20131.16),\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.028] were associated with increased 30-day mortality. There was no significant association between BMI groups and post-operative stroke or duration of ventilation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1845403","type":"journal-article","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T04:30:36Z","timestamp":1789533036000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of body mass index on outcomes in acute type A aortic dissection"],"prefix":"10.3389","volume":"13","author":[{"given":"Adam H.","family":"Kiridly","sequence":"first","affiliation":[{"name":"Department of Cardiothoracic Surgery, Northwell Health","place":["New Hyde Park, NY, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stevan S.","family":"Pupovac","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Northwell Health","place":["New Hyde Park, NY, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Dell'Aquila","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Northwell Health","place":["New Hyde Park, NY, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paley","family":"Arnone","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Northwell Health","place":["New Hyde Park, NY, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar A.","family":"Jarral","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Northwell Health","place":["New Hyde Park, NY, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Branden","family":"Tejada","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Northwell Health","place":["New Hyde Park, NY, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian","family":"Mason","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Northwell Health","place":["New Hyde Park, NY, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Kalimi","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Northwell Health","place":["New Hyde Park, NY, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. Jacob","family":"Scheinerman","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Northwell Health","place":["New Hyde Park, NY, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan R.","family":"Hartman","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Northwell Health","place":["New Hyde Park, NY, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Derek R.","family":"Brinster","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Northwell Health","place":["New Hyde Park, NY, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,16]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1186\/s13019-021-01558-z","article-title":"Impact of body mass index on early and mid-term outcomes after surgery for acute Stanford 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