Pfeiffer Philipp, Wittemann Karen, Mattern Leon, Buchholz Vanessa, El Beyrouti Hazem, Ghazy Ahmed, Oezkur Mehmet, Duerr Georg Daniel, Probst Chris, Treede Hendrik, Dohle Daniel-Sebastian
Department of Cardiovascular Surgery, University Medical Center Mainz, 55131 Mainz, Germany.
Life (Basel). 2024 Jul 30;14(8):955. doi: 10.3390/life14080955.
A paradox of lower morbidity and mortality in overweight or obese patients undergoing cardiac surgery has been described; however, knowledge about the influence of obesity in patients with acute Type A aortic dissection (AAD) is limited. This study aimed to evaluate the effect of obesity on short- and long-term outcomes after surgical treatment for AAD.
Between 01/2004 and 12/2022, 912 patients with a BMI of 18.5 or greater were operated on for AAD. Patients were grouped according to their BMI (normal weight: BMI 18.5-24.9, = 332; overweight: BMI 25-29.9, = 367; obesity class I: BMI 30-34.9, = 133; obesity class II+: BMI ≥ 35, = 67), and the obtained clinical and surgical data were compared.
Obese patients were younger at the time of AAD ( = 0.001) and demonstrated higher rates of typical cardiovascular comorbidities (arterial hypertension, = 0.005; diabetes mellitus, < 0.001). The most important preoperative parameters, as well as the surgical approach, were similar between all four groups. The occurrence of renal failure requiring dialysis was higher in patients with BMI ≥ 35 ( = 0.010), but the in-hospital ( = 0.461) and long-term survival ( = 0.894) showed no significant differences.
There are no indications that the obesity paradox is applicable in the setting of AAD. Since obese patients are affected by AAD at a younger age, obesity might constitute a risk factor for AAD. However, obesity does not influence short- or long-term survival. Regardless of body weight, immediate surgical therapy remains the treatment of choice for AAD.
已有研究描述了超重或肥胖的心脏手术患者发病率和死亡率较低这一矛盾现象；然而，关于肥胖对急性A型主动脉夹层（AAD）患者的影响的了解有限。本研究旨在评估肥胖对AAD手术治疗后短期和长期结局的影响。
在2004年1月至2022年12月期间，912例体重指数（BMI）为18.5或更高的患者接受了AAD手术。根据BMI将患者分组（正常体重：BMI 18.5 - 24.9，n = 332；超重：BMI 25 - 29.9，n = 367；I类肥胖：BMI 30 - 34.9，n = 133；II +类肥胖：BMI≥35，n = 67），并比较获得的临床和手术数据。
AAD发病时肥胖患者更年轻（P = 0.001），且典型心血管合并症发生率更高（动脉高血压，P = 0.005；糖尿病，P < 0.001）。所有四组之间最重要的术前参数以及手术方式相似。BMI≥35的患者需要透析的肾衰竭发生率更高（P = 0.010），但住院期间（P = 0.461）和长期生存率（P = 0.894）无显著差异。
没有迹象表明肥胖悖论适用于AAD患者。由于肥胖患者在较年轻时受AAD影响，肥胖可能是AAD的一个危险因素。然而，肥胖并不影响短期或长期生存。无论体重如何，立即手术治疗仍然是AAD的首选治疗方法。
