The Clinical Significance of Unplanned Coronary Artery Bypass Grafting in Aortic Root Replacement

Abstract

ObjectivesUnexpected coronary artery bypass grafting (CABG) is occasionally required during aortic root replacement (ARR). However, the impact of unplanned CABG remains unknown. DesignSingle center, retrospective observational study. SettingA university-affiliated tertiary hospitals. ParticipantsAll patients who underwent ARR from 2011 through 2022 InterventionsARR with or without unplanned CABG Measurements and Main ResultsA total of 795 patients underwent ARR. Among them, 131 (16.5%) underwent planned concomitant CABG and 34 (4.3%) required unplanned CABG. The most common indication of unplanned CABG was ventricular dysfunction (33.3%), followed by disease pathology (25.6%), anatomy (15.4%), and surgical complications (10.3%). A vein graft to the right coronary artery was the most commonly performed bypass. Infective endocarditis and aortic dissection were observed in 27.8% and 12.8%, respectively. Prior cardiac surgery was seen in 40.3%. The median follow-up period was 4.3 years. Unplanned CABG was not associated with operative mortality (OR 1.54, 95% CI 0.33-7.16, P = .58) or long-term mortality (HR 0.91, 95% CI 0.44-1.89, P = .81). Body surface area smaller than 1.7 was independently associated with an increased risk of unplanned CABG (OR 4.51, 95% CI 1.85-11.0, P < .001). ConclusionsUnplanned CABG occurred in 4.3% during ARR but was not associated with operative mortality or long-term mortality. A small body surface area was a factor associated with unplanned CABG.