Impact of concomitant coronary artery bypass grafting on the outcomes of total arch repair with frozen elephant trunk for type an aortic dissection.

Abstract

Coronary artery bypass grafting (CABG) is often performed alongside type A aortic dissection (TAAD) repair. However, the association between concomitant CABG and the clinical outcomes of TAAD repair remains uncertain. This study included 1,002 consecutive TAAD patients who underwent total aortic arch replacement (TAR) with frozen elephant trunk (FET) from June 2019 to January 2024. Concomitant CABG during TAR and FET was performed under three conditions: planned CABG for coronary ostial involvement, planned CABG for coronary artery disease, and rescue CABG. Patients who underwent rescue CABG(N = 42) were compared with those who had planned CABG (N = 218) and those who did not undergo CABG (non-CABG: N = 742). Logistic regression, Kaplan-Meier, and Cox regression analyses were employed. Operative mortality rate was 2.40%; 42(4.19%) patients underwent rescue CABG. The rescue CABG group had the highest operative mortality (23.81%) among the three groups (p < 0.001). Rescue CABG was associated with increased operative mortality compared with non-CABG [odds ratio : 18.96, 95%confidence interval (CI):7.32-49.08, P < 0.001], whereas planned CABG was not significant. The median follow-up period was 24.80 (interquartile range : 11.73-39.10) months. Kaplan-Meier analysis demonstrated poorer overall survival in the rescue CABG group (log-rank p-value < 0.001). Rescue CABG significantly increased all-cause late mortality compared with non-CABG (hazard ratio : 13.69, 95% CI : 6.53-28.70, P < 0.001), while planned CABG did not. The 2-year cumulative incidence of graft occlusion among CABG patients was 24.54%. Rescue CABG is significantly associated with increased operative and all-cause mortality in patients undergoing TAR and FET for TAAD. Further research is required to identify the causes of rescue CABG.