Salvage Coronary Artery Bypass Predicts Increased Mortality During Aortic Root Operation

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Cardiac Surgery Outcomes

Background:

• Aortic root replacement (ROOT) is a standard procedure.
• The impact of combined coronary artery bypass grafting (CABG) with ROOT (CABG-R) on patient outcomes is not well-established.
• This study investigates the influence of concomitant CABG on ROOT procedures.

Purpose of the Study:

• To evaluate the outcomes of aortic root replacement (ROOT) with and without concurrent coronary artery bypass grafting (CABG).
• To identify factors influencing outcomes in patients undergoing CABG-R.

Main Methods:

• Retrospective review of 867 patients undergoing non-emergent ROOT from 2004 to 2016.
• Patients were stratified into ROOT and CABG-R groups.
• Propensity-score weighted analysis was used to compare outcomes.

Main Results:

• CABG-R patients were older and had more comorbidities than the ROOT-only group.
• Thirty-day mortality was significantly higher in the CABG-R group (15.4%) compared to the ROOT group (3.4%).
• Mortality was highest for CABG for ventricular failure (28.8%), followed by anatomy (22.9%), and lowest for coronary artery disease (6.3%).

Conclusions:

• Combined CABG-R increases postoperative morbidity and mortality compared to isolated ROOT.
• The indication for CABG significantly impacts outcomes; CABG for coronary artery disease had similar results to isolated ROOT.
• Urgent CABG for acute ventricular failure carries the highest risk, highlighting the importance of successful coronary reimplantation.