Effect of Concomitant Coronary Artery Bypass Grafting on Outcomes of Ascending Aorta Replacement
N Bryce Robinson1, Irbaz Hameed1, Ajita Naik1
1Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York.
Insights
Concomitant coronary artery bypass grafting (CABG) with ascending aorta replacement (AAR) does not increase major adverse events. This finding is crucial for surgical decision-making in patients requiring both procedures.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Aortic Surgery
Background:
- Ascending aorta replacement (AAR) is a safe procedure in high-volume centers.
- The impact of concurrent coronary artery bypass grafting (CABG) on AAR outcomes is not well-established.
Purpose of the Study:
- To evaluate the effect of concomitant CABG on postoperative outcomes in patients undergoing ascending aorta replacement (AAR).
Main Methods:
- Retrospective review of a prospectively maintained institutional database (1997-2018).
- Patients undergoing AAR were stratified into AAR alone versus AAR with CABG (1 or >1 graft).
- Exclusion of aortic dissection and root replacement cases; primary endpoint was major adverse events (MAE).
Main Results:
- 951 patients analyzed: 725 (76.2%) AAR alone, 226 (23.8%) AAR with CABG.
- Operative mortality was similar (1.8% vs 0.8%, P=.40).
- Unadjusted MAE incidence was higher in AAR with CABG (5.8% vs 1.9%, P=.005), but multivariable analysis showed no association between CABG and MAE (P>.07 for 1 or >1 CABG).
Conclusions:
- Concomitant coronary artery bypass grafting (CABG) during ascending aorta replacement (AAR) is not associated with an increased risk of major adverse events.
- Preoperative pulmonary dysfunction was the only independent predictor of MAE.
- These findings support the safety of performing CABG concurrently with AAR when indicated.
Background:
Ascending aorta replacement can be performed safely in high-volume centers. What remains unknown is whether concomitant coronary revascularization with bypass grafting affects postoperative outcomes.
Methods:
This study retrospectively reviewed a prospectively maintained institutional database for patients who underwent ascending aorta replacement (AAR) during the period from 1997 to 2018. Patients were stratified into AAR alone (AAR) vs AAR and coronary artery bypass graft (AAR with CABG), further categorized as 1 or more than 1 CABG. Aortic dissection and root replacement cases were excluded. The primary end point consisted of major adverse events (MAE), including operative mortality, perioperative myocardial infarction, stroke, need for tracheostomy, and need for dialysis. Secondary end points were operative mortality, each MAE component, and late survival.
Results:
A total of 951 patients were included in the analysis; 725 (76.2%) underwent isolated AAR, and 226 (23.8%) underwent AAR with CABG. Operative mortality was similar across the 2 groups (1.8% for AAR with CABG and 0.8% for AAR; P = .40). The unadjusted incidence of MAE was higher in the AAR with CABG group (5.8% vs 1.9%; P = .005).). On multivariable analysis, the performance of 1 CABG (odds ratio [OR], 1.90; 95% confidence interval [CI], 0.67 to 5.33; P = .23) and more than 1 CABG (OR, 2.65; 95% CI, 0.93 to 7.53; P = .07) was not associated with higher rates of MAE. Preoperative pulmonary dysfunction (OR, 2.51; 95% CI, 1.07 to 5.85; P = .03) was the only independent predictor of MAE.
Conclusions:
In patients undergoing concomitant CABG with AAR, the performance of concomitant CABG is not associated with an increased risk of MAE.
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