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Planned Versus Emergency Coronary Artery Bypass Grafting During Elective Aortic Root Replacement: Short- and

Eilon Ram1, Christopher Lau1, Alexander Gregg1

  • 1Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY 10065, United States.

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|July 30, 2025
PubMed

Insights

Coronary artery bypass grafting (CABG) during aortic root replacement (ARR) increases operative mortality but does not impact long-term survival. Females and patients with small aortic roots face higher risks for emergency CABG.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Cardiac Surgery

Background:

  • Aortic root replacement (ARR) is a complex procedure often requiring concomitant interventions.
  • Coronary artery bypass grafting (CABG) may be necessary during ARR, influencing patient outcomes.
  • Understanding the impact of CABG on ARR outcomes is crucial for surgical planning and patient management.

Purpose of the Study:

  • To evaluate the impact of concomitant coronary artery bypass grafting (CABG) on outcomes in patients undergoing aortic root replacement (ARR).
  • To identify risk factors associated with the need for emergency CABG during ARR.

Main Methods:

  • Retrospective cohort study of patients undergoing elective aortic root replacement (ARR).
  • Patients were stratified into isolated ARR and ARR with concomitant CABG groups.
  • Multivariable regression and survival analysis were used to compare outcomes.

Main Results:

  • Patients requiring CABG were older, had more comorbidities, and included a higher proportion of females and those with smaller aortic roots.
  • Operative mortality was significantly higher in patients undergoing CABG compared to isolated ARR (1.8% vs 0.2%).
  • Emergency CABG was associated with higher operative mortality (11.1%) and increased postoperative complications, including respiratory and renal dysfunction.

Conclusions:

  • Concomitant CABG, both elective and emergency, increases operative risk in ARR patients but does not compromise long-term survival.
  • Female sex and smaller aortic root size are risk factors for requiring emergency CABG during ARR.
  • Risk stratification and careful surgical planning are essential for patients undergoing ARR with potential need for CABG.
Abstract

Keywords:
aortic valve sparing surgerycomposite valve graftcoronary artery bypass graftingcoronary artery diseaseroot replacement

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