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Propensity score analysis in patients with and without previous isolated coronary artery bypass grafting who require
Ourania Preventza1, Hiruni Amarasekara2, Matt D Price2
1Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Tex.
Insights
Previous isolated coronary artery bypass grafting (CABG) does not increase adverse outcomes in patients undergoing proximal aortic or arch surgery. This finding offers a benchmark for future endovascular therapies in complex aortic cases.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
Background:
- The impact of prior isolated coronary artery bypass grafting (CABG) on outcomes of proximal aortic or aortic arch surgery is not well-defined.
- Patients undergoing complex aortic procedures often have significant comorbidities, including prior cardiac surgeries.
Purpose of the Study:
- To compare outcomes of ascending aortic and aortic arch surgery in patients with and without a history of isolated CABG.
- To determine if previous isolated CABG is an independent predictor of adverse events in this patient population.
Main Methods:
- A propensity score-matched analysis was conducted on 252 patients (126 with previous isolated CABG, 126 without) who underwent proximal aortic surgery.
- Procedures included ascending aortic and total arch repairs, with 44% being emergency operations.
- Outcomes such as operative mortality, 30-day mortality, stroke, and renal failure were compared using Kaplan-Meier survival curves.
Main Results:
- No statistically significant differences were observed in operative mortality (15.9% vs 11.1%), 30-day mortality (13.5% vs 7.1%), persistent stroke (6.3% vs 4.8%), or renal failure requiring hemodialysis (7.9% vs 4.0%) between groups.
- Previous isolated CABG was not an independent predictor of adverse outcomes, though it was associated with increased need for intra-aortic balloon support (P < .01).
- Long-term survival showed a trend towards significance (P = .06) but did not reach statistical significance.
Conclusions:
- In this large cohort study, previous isolated CABG did not independently predict adverse outcomes in patients undergoing proximal aortic or aortic arch surgery.
- These findings, potentially specific to centers of excellence, suggest that prior CABG is a manageable comorbidity in complex aortic surgery.
- The results can serve as a benchmark for evaluating novel endovascular treatments for aortic diseases.
Objective:
The risk posed by previous isolated coronary artery bypass grafting (CABG) in patients who require proximal aortic or aortic arch surgery is unclear. We compared outcomes of ascending aortic and arch procedures in patients with and without previous CABG.
Methods:
Using propensity scores, we created 2 matched groups of patients who underwent proximal aortic surgery, including total arch repairs, at our institution: 126 patients who underwent isolated CABG before the index operation and 126 without previous CABG. Forty-four percent of aortic operations were emergency procedures. Eighty-six patients had a patent previous left internal mammary graft. We compared outcomes between the 2 groups and calculated Kaplan-Meier survival curves.
Results:
The following outcomes were recorded for the patients with previous isolated CABG versus no CABG: operative mortality, 15.9% versus 11.1% (P = .3); 30-day mortality, 13.5% versus 7.1% (P = .1); persistent stroke, 6.3% versus 4.8% (P = .6); and renal failure necessitating hemodialysis at discharge, 7.9% versus 4.0% (P = .2). Previous CABG did not independently predict any adverse outcome, even though patients who underwent previous CABG more frequently needed intra-aortic balloon support (P < .01). The P value for the overall intergroup difference in long-term survival was .06.
Conclusions:
This is one of the largest studies yet reported to examine the impact of previous isolated CABG on proximal aortic or arch surgery outcomes. Although these results may be specific to aortic centers of excellence, in this complicated patient cohort, previous isolated CABG did not independently predict any adverse outcome. These results could serve as a benchmark for assessing future endovascular therapies.
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