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Aortic arch repair with coronary artery revascularization
Hiroki Wakamatsu1, Yoichi Sato, Shinya Takase
1Department of Cardiovascular Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan. hitoshiy@fmu.ac.jp
Fukushima Journal of Medical Science
|July 9, 2010
Summary
Off-pump coronary artery bypass (CAB) combined with aortic arch repair reduced myocardial ischemia and cardiopulmonary bypass times compared to on-pump CAB. This approach offers a viable option for patients with aortic aneurysms and coronary artery disease.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Cardiac Surgery
Background:
- Simultaneous aortic arch repair and coronary artery bypass grafting (CABG) carry significant risks.
- Evaluating surgical techniques for combined aortic arch repair and CABG is crucial for improving patient outcomes.
Purpose of the Study:
- To compare the outcomes of on-pump (ONCAB) versus off-pump (OPCAB) coronary artery bypass grafting in conjunction with aortic arch repair.
- To assess the safety and efficacy of OPCAB in patients with aortic arch aneurysms and coronary artery disease.
Main Methods:
- Retrospective analysis of patients undergoing aortic arch repair combined with CABG.
- Patients were divided into ONCAB (n=14) and OPCAB (n=18) groups.
- A control group of isolated total arch replacement (TAR, n=20) was also analyzed.
Main Results:
- OPCAB group demonstrated significantly shorter myocardial ischemia (133 vs. 180 min) and cardiopulmonary bypass times (239 vs. 306 min) compared to ONCAB.
- Postoperative ventilation duration was lower (33% vs. 79%) and peak CK-MB levels were reduced in the OPCAB group.
- In-hospital mortality was 6% for OPCAB versus 21% for ONCAB (P=0.210).
- OPCAB outcomes were comparable to the isolated TAR group.
Conclusions:
- Aortic arch repair with OPCAB is a safe and effective option for patients with aortic aneurysms and concurrent coronary artery disease.
- OPCAB minimizes myocardial ischemia and cardiopulmonary bypass duration, potentially reducing morbidity associated with combined procedures.
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