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Unplanned coronary artery bypass grafting during elective aortic root surgery increases perioperative morbidity and

Alexandra E Sperry1, Sankrit R Kapoor1, Nimesh D Desai1,2

  • 1Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pa.

JTCVS Open
|April 10, 2026
PubMed

Insights

Unplanned intraoperative coronary artery bypass grafting (CABG) during elective aortic root replacement (ARR) significantly increases mortality and complications. Female sex is a key risk factor for requiring CABG during ARR.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Cardiac Surgery

Background:

  • Elective aortic root replacement (ARR) is a complex procedure.
  • Unplanned intraoperative coronary artery bypass grafting (CABG) may be necessary during ARR.
  • Understanding risk factors and outcomes associated with unplanned CABG is crucial for patient management.

Purpose of the Study:

  • To evaluate risk factors for requiring unplanned intraoperative coronary artery bypass grafting (CABG) during elective aortic root replacement (ARR).
  • To assess the clinical outcomes and mortality associated with unplanned CABG in patients undergoing elective ARR.

Main Methods:

  • Retrospective, multicenter study of elective ARR procedures from 2014-2022.
  • Comparison of baseline and intraoperative characteristics between patients who did and did not require unplanned CABG (UC).
  • Multivariate logistic regression and Kaplan-Meier survival analysis were used to identify predictors of UC and 30-day mortality.

Main Results:

  • 3.4% of patients (30/884) required UC during elective ARR.
  • Patients requiring UC had higher rates of female sex (63.3% vs 19.8%), longer cardiopulmonary bypass times, and increased use of the Bentall procedure.
  • UC was an independent risk factor for 30-day mortality (OR, 10.4), with female sex strongly associated with the need for UC (OR, 6.46).

Conclusions:

  • Unplanned CABG during elective aortic root surgery significantly increases major complications and 30-day mortality.
  • Female sex is a significant risk factor for requiring unplanned CABG during elective ARR.
  • Non-dominant right coronary artery anatomy was not found to be a risk factor for UC.
Abstract

Keywords:
aortic root replacementcoronary artery bypass grafting

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