Risk Profile and Outcomes of Patients Requiring Coronary Revascularization as Concomitant Procedure to Repair of Type...

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Aortic Surgery

Background:

• Acute type A aortic dissection is a life-threatening condition requiring surgical intervention.
• Concomitant coronary artery bypass grafting (CABG) may be necessary during aortic dissection repair.
• Understanding outcomes and risk factors for CABG in this population is critical.

Purpose of the Study:

• To report early and late clinical outcomes of patients undergoing surgical repair for acute type A aortic dissection with concomitant CABG.
• To identify risk factors associated with the need for CABG during type A aortic dissection repair.

Main Methods:

• Data from the multicenter European Registry of Type A Aortic Dissection (ERTAAD) were analyzed.
• Multivariable logistic regression models were used to identify predictors of hospital death and CABG necessity.
• Statistical analysis included bootstrapped least absolute shrinkage and selection operator (LASSO) logistic regression.

Main Results:

• 8.04% of patients (292/3633) required additional CABG during aortic dissection repair.
• In-hospital mortality was significantly higher in patients undergoing CABG (33%) compared to non-CABG recipients (16%).
• Predictors for CABG included aortic root dissection involving the right coronary cusp, aortic root tear, mitral valve insufficiency, and genetic syndrome.

Conclusions:

• The need for CABG during type A aortic dissection repair is not infrequent and is associated with increased mortality.
• Preoperative evaluation of intimal tear localization and right coronary sinus dissection is essential for risk stratification.
• Careful preoperative assessment aids in planning the most appropriate surgical approach for patients requiring revascularization.