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Novel and Innovative Hybrid Technique for Type A Aortic Dissection
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Differential Outcomes of Indication-Specific Coronary Artery Bypass Grafting in Acute Type A Aortic Dissection

Kai Zhang1, Chenyu Zhou2, Shiqi Gao2

  • 1Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 10029, China.

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|August 4, 2025
PubMed

Insights

Coronary artery bypass grafting for heart failure after declamping in acute type A aortic dissection increases early mortality. However, bypass grafting for coronary artery disease may decrease long-term survival.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Aortic Disease

Background:

  • Acute type A aortic dissection is a life-threatening condition requiring prompt surgical intervention.
  • Concomitant coronary artery bypass grafting (CABG) is sometimes necessary during aortic dissection repair.
  • The impact of different CABG indications on outcomes in these patients is not fully understood.

Purpose of the Study:

  • To analyze the effect of various indications for CABG on early mortality and long-term outcomes in patients with acute type A aortic dissection.
  • To stratify outcomes based on CABG for coronary artery dissection, coronary artery disease (CAD), or heart failure after declamping (HFD).

Main Methods:

  • Retrospective analysis of 972 patients undergoing emergency surgical repair for acute type A aortic dissection between 2010 and 2018.
  • Patients were categorized by the presence and indication for concomitant CABG.
  • Outcomes including 30-day mortality and 10-year survival were compared across subgroups.

Main Results:

  • The 30-day mortality was significantly higher in patients who underwent CABG (15.1%) compared to those who did not (5.6%).
  • CABG for HFD was associated with increased 30-day mortality (OR 3.90).
  • While HFD patients had non-inferior late survival, patients undergoing CABG for CAD showed the lowest long-term survival rate.

Conclusions:

  • CABG for HFD significantly increases early mortality risk but does not impact long-term survival.
  • CABG for CAD does not affect 30-day mortality but is associated with decreased long-term survival.
  • Careful consideration of CABG indications is crucial in managing acute type A aortic dissection.
Abstract

Keywords:
acute type A aortic dissectionaortic operationcoronary artery bypass graftingcoronary malperfusionlong-term outcomes

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