Unplanned coronary artery bypass graft in aortic root replacement†

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Cardiac Surgery

Background:

• Aortic root replacement (ARR) is a complex procedure, and unexpected difficulties during coronary artery reimplantation can necessitate additional interventions.
• Coronary artery bypass graft (CABG) may be required intraoperatively if coronary artery reimplantation is challenging.

Purpose of the Study:

• To investigate the outcomes of patients undergoing ARR who require an unplanned CABG.
• To identify factors associated with the need for unplanned CABG during ARR.

Main Methods:

• Retrospective analysis of 2416 patients undergoing ARR across two centers from 2004 to 2021.
• Exclusion of planned CABG; concomitant CABG defined as unplanned. Propensity score matching (PSM) used for comparison.
• Landmark analysis at 90 days and multivariable logistic regression to assess mortality and associated factors.

Main Results:

• Unplanned CABG was performed in 8.4% of patients for various reasons, including coronary button issues and dissection.
• The unplanned CABG group showed significantly higher in-hospital mortality, stroke, renal failure, and respiratory failure rates post-PSM.
• Factors associated with unplanned CABG included female sex, chronic kidney disease, reoperation, dissection, endocarditis, and concomitant arch replacement; valve-sparing root replacement was protective.

Conclusions:

• Unplanned CABG during ARR is associated with increased operative mortality and is often required in surgically complex scenarios.
• Patients undergoing ARR with unplanned CABG experience significantly reduced survival probabilities, both early and long-term.