Outcomes after elective total aortic arch replacement: Does obesity matter?

Obesity is a chronic disease linked to high mortality and morbidity after cardiac procedures, but its relationship to outcomes after total aortic arch replacement (TAR) remains unclear. We examined TAR data to determine whether obesity is associated with greater perioperative risk.

Among 787 TARs performed from 1990 to 2023, we excluded patients who lacked body mass index (BMI) data, had nonelective or nonstandard repairs, or were underweight (BMI <18.5 kg/m²). The remaining 521 patients did not have obesity (18.5 ≤BMI <30; n = 389) or did (BMI ≥30; n = 132). Patients with obesity were class 1 (30 ≤ BMI < 35), class 2 (35 ≤ BMI < 40), or class 3 (BMI ≥40). We compared preoperative and perioperative variables for BMI ≥30 (obesity) versus BMI <30. Adverse events were operative mortality, persistent stroke, spinal cord deficit, and renal failure. We performed multivariable logistic regression and Kaplan-Meier survival analysis.

Patients with obesity had greater rates of obstructive sleep apnea, transient spinal cord deficit, and acute renal dysfunction than patients with normal weight. During repair, the use of antegrade cerebral perfusion often exceeded 30 minutes in patients with obesity. Operative mortality and adverse events did not differ among BMI or obesity groups. Greater BMI was not predictive of operative mortality, whereas chronic kidney disease (odds ratio, 2.28; P = .01), pulmonary disease (1.87, P < .001), longer aortic clamp time (1.01, P = .03), and antegrade cerebral perfusion time >30 minutes (2.17, P = .047) were. Survival did not differ significantly by obesity status.

Obesity was not associated with operative mortality or adverse events in patients who underwent TAR. Therefore, patients should not be deemed ineligible for TAR on the basis of obesity alone.