Abstract
Coronary Artery Bypass Grafting (CABG) is sometimes necessary in acute Type A Aortic Dissection (AAAD) repair. The aim of this study is to analyze the incidence, indications and influence in-hospital outcomes of AAAD repair requiring concomitant CABG in a high-volume single-center experience. Retrospective study of all consecutive AAAD patients. Those who underwent concomitant CABG were identified. Preoperative, intraoperative, postoperative and follow-up data were collected and analyzed. Between January 1, 2010 and December 31, 2016, 382 patients underwent emergency surgery for AAAD. Forty-one (10.7%) underwent concomitant CABG. In this group, mean age was 64 ± 14 years, 32 were male (78%). Indication for CABG was coronary dissection in 28 patients (68.3%), post-cardiopulmonary bypass (CPB) right heart failure in 7 (17.1%), post CPB left heart failure in (7.3%) and native coronary pathology in 3 (7.3%). In 33 (80.5%) one graft was needed, in 7 (17%) two were performed and in 1 patient (2.4%) 3 were necessary. The right coronary artery (RCA) was the only revascularized vessel in 26 cases (63.4%), the left coronary artery (LCA) alone in 11 (26.8%), and both coronary systems in 4 (9.8%). In-hospital mortality was 51.2% (N = 21); eight (19.5%) patients had postoperative myocardial infarction (MI) and 11 (26.8%) had a major neurological event. Multivariable logistic regression identified concomitant CABG as a predictor of in-hospital mortality (Odds Ratio (OR) = 3.8115, 95% CI= 0.514-2.138, p = 0.001). In our study, concomitant CABG was performed in 10.7% of AAAD repair surgery and it was associated with high in-hospital mortality.
Highlights
acute Type A Aortic Dissection (AAAD) is a surgical emergency associated with high mortality, reaching up to 100% if not promptly treated.[1]
We identified the group of 41 patients (10.7%) who required concomitant Coronary Artery Bypass Grafting (CABG) (CABG group), which is the focus of this study
Variable Cardiopulmonary bypass time Aortic cross-clamping time Antegrade selective cerebral perfusion Cerebral perfusion time Hypothermia (C°) Ascending Aorta replacement Isolated With hemiarch replacement With complete arch replacement Aortic root reconstruction Aortic Root replacement With mechanical valve With Biological valve Other Graft number CABG x 1 CABG x 2 CABG x 3 Graft location right coronary artery (RCA) alone RCA + left Left alone
Summary
AAAD is a surgical emergency associated with high mortality, reaching up to 100% if not promptly treated.[1]. Surgical strategies for AAAD are preoperatively planned according to clinical, morphological and radiological characteristics of the patient and the dissection, but can often change during the course of the operation. The need to perform CABG in the setting of AAAD is not a rare event; several studies report an incidence ranging from 3% to 20%.1À3 the causes, characteristics and impact on outcomes are still not well reported in the literature. Our Department is a major referral center for aortic surgery performing between 50 and 70 cases of AAAD repair annually. We hypothesized that the need of concomitant CABG during surgery for AAAD may be associated with increased mortality. The objective of this study was to report its incidence, indications, target vessel and in-hospital outcomes (Fig. 1), in particular the impact of CABG on in-hospital mortality
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
