{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T18:42:23Z","timestamp":1785436943640,"version":"3.56.0"},"reference-count":36,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T00:00:00Z","timestamp":1778889600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Berta-Ottenstein-Programme for Advanced Clinician Scientists, Faculty of Medicine, University of Freiburg"},{"id":[{"id":"https:\/\/ror.org\/0245cg223","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: This study aimed to evaluate the impact of body mass index (BMI) on post- operative outcomes in patients undergoing aortic arch repair with the frozen elephant trunk technique (FET). Materials and Methods: A total of 387 patients who underwent an FET procedure between 04\/2014 and 11\/2024 were retrospectively analyzed. Patients were divided into four groups according to BMI: underweight (BMI &lt; 18.5, n = 12) normal weight (BMI: 18.5 to &lt;25, n = 150), overweight (BMI: 25 to &lt;30, n = 154), and obese (BMI: \u226530, n = 71). Patient characteristics and clinical outcomes were compared across groups. Multivariable Cox regression, interaction analysis, and restricted cubic spline modelling were performed using R (Version 4.4.3). Results: Interaction analysis revealed BMI-dependent effect modification for several predictors. Insulin-dependent diabetes mellitus was associated with increased mortality only in patients with BMI &lt; 25 kg\/m2 (interaction p = 0.003). Transfusion of packed red blood cells (PRBCs) also showed a significant interaction with BMI (p = 0.016), with a stronger effect in patients with BMI &lt; 25 kg\/m2, although significant in both strata. Moreover, cross-clamp time demonstrated a BMI-dependent interaction (p = 0.047), with numerically higher mortality hazards in overweight patients (BMI &gt; 25 kg\/m2), but without statistically significant subgroup effects. Spline analysis indicated a non-linear, threshold-based association between overall mortality and BMI but does not reach statistical significance. Kaplan\u2013Meier analysis showed no significant difference in 5-year survival among BMI categories. Conclusions: BMI should not be used as a primary risk stratification tool for survival after an FET procedure. Rather, attention should be paid to comorbid conditions and intraoperative factors that interact with BMI. For patients with lower BMI (&lt;25 kg\/m2), optimizing glycemic control and minimizing transfusion may improve outcomes. Data suggests that a reduction in cross-clamp time may be particularly beneficial in patients with higher BMI (&gt;25 kg\/m2). Future studies should aim to clarify the impact of BMI on outcomes after FET, particularly in the context of patient selection and perioperative optimization strategies.<\/jats:p>","DOI":"10.3390\/medicina62050973","type":"journal-article","created":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T10:19:52Z","timestamp":1779877192000},"page":"973","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Weighing the Risks: The Impact of Body Mass Index on Outcomes After Frozen Elephant Trunk Aortic Arch Repair"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1888-2502","authenticated-orcid":false,"given":"Tim","family":"Walter","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Surgery, Heart Centre Freiburg University, University Medical Centre Freiburg, 79106 Freiburg, Germany"},{"name":"Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Kletzer","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Heart Centre Freiburg University, University Medical Centre Freiburg, 79106 Freiburg, Germany"},{"name":"Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6263-9123","authenticated-orcid":false,"given":"Tim","family":"Berger","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Heart Centre Freiburg University, University Medical Centre Freiburg, 79106 Freiburg, Germany"},{"name":"Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salome","family":"Chikvatia","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Heart Centre Freiburg University, University Medical Centre Freiburg, 79106 Freiburg, Germany"},{"name":"Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-2331-0228","authenticated-orcid":false,"given":"Magdalena","family":"Bork","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Heart Centre Freiburg University, University Medical Centre Freiburg, 79106 Freiburg, Germany"},{"name":"Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophie","family":"Kunzmann","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Heart Centre Freiburg University, University Medical Centre Freiburg, 79106 Freiburg, Germany"},{"name":"Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Lescan","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Heart Centre Freiburg University, University Medical Centre Freiburg, 79106 Freiburg, Germany"},{"name":"Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1892-1487","authenticated-orcid":false,"given":"Stoyan","family":"Kondov","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Heart Centre Freiburg University, University Medical Centre Freiburg, 79106 Freiburg, Germany"},{"name":"Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aleksandar","family":"Dimov","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Heart Centre Freiburg University, University Medical Centre Freiburg, 79106 Freiburg, Germany"},{"name":"Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Czerny","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Heart Centre Freiburg University, University Medical Centre Freiburg, 79106 Freiburg, Germany"},{"name":"Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3099-7254","authenticated-orcid":false,"given":"Maximilian","family":"Kreibich","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Heart Centre Freiburg University, University Medical Centre Freiburg, 79106 Freiburg, Germany"},{"name":"Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dalibor","family":"Bockelmann","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Heart Centre Freiburg University, University Medical Centre Freiburg, 79106 Freiburg, Germany"},{"name":"Staff Unit for Medical Strategy and Cooperation, University Clinic Freiburg, 79106 Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Chivasso, P., Mastrogiovanni, G., Miele, M., Bruno, V.D., Rosciano, A., Montella, A.P., Triggiani, D., Colombino, M., Cafarelli, F., and Leone, R. 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