Destruction of the Button: Unplanned CABG in Aortic Root Replacement Significantly Increases Mortality
Presented During:
Thursday, April 25, 2024: 5:38PM - 7:00PM
Sheraton Times Square
Posted Room Name:
Central Park
Abstract No:
P0098
Submission Type:
Abstract Submission
Authors:
Adam Carroll (1), Michael Kirsch (1), Nicolas Chanes (1), Bo Chang Wu (1), Muhammad Aftab (1), T. Brett Reece (1)
Institutions:
(1) University of Colorado Anschutz, Denver, CO
Submitting Author:
Adam Carroll
-
Contact Me
University of Colorado Anschutz
University of Colorado Anschutz
Co-Author(s):
Michael Kirsch
-
Contact Me
University of Colorado Anschutz
University of Colorado Anschutz
Nicolas Chanes
-
Contact Me
University of Colorado Anschutz
University of Colorado Anschutz
Bo Chang Wu
-
Contact Me
University of Colorado Anschutz
University of Colorado Anschutz
*Muhammad Aftab
-
Contact Me
University of Colorado Anschutz
University of Colorado Anschutz
*T. Brett Reece
-
Contact Me
University of Colorado Anschutz
University of Colorado Anschutz
Presenting Author:
Adam Carroll
-
Contact Me
University of Colorado Anschutz
University of Colorado Anschutz
Abstract:
Objective
Advances in aortic root replacement substitutes and surgical technique have significantly improved outcomes. However, re-implantation of the coronaries can carry significant risk when the coronary buttons are of poor quality, potentially compromising cardiac function due to malperfusion. Prior studies have suggested that when re-do root replacement is performed, unplanned CABG increases mortality, but no study has focused solely on comparing the two groups regardless of prior procedure. We compared patients who underwent aortic root replacement with concomitant coronary artery bypass grafting (CABG) at our institution, reviewing their pre-operative and operative characteristics, and subsequent outcomes.
Methods
We reviewed aortic root replacements with simultaneous CABG at our institution from 2011-2023 using our prospectively maintained retrospective database. Patients were stratified into two cohorts based on whether the CABG was unplanned or planned. In total, 33 patients were identified that underwent root replacement with concomitant CABG.
Results
In total, 11 CABG were unplanned, and 22 were planned. In all unplanned cases, the CABG was performed due to poor quality of the coronary button. Seven unplanned patients required mechanical circulatory support, compared to one planned patient (p=0.006). Cardiopulmonary bypass (p=0.001) and circulatory arrest (p=0.33) when an adjunctive aortic procedure was performed were significantly higher in the unplanned group. Intraoperative RBC (p=0.039) and FFP (p=0.007) administration was higher in the unplanned group, with most patients left with an open chest (p<0.001). Post-operatively, unplanned CABG patients required prolonged ventilation (p=0.003), and most patients died during their hospitalization (p=0.018).
Conclusion
Unplanned CABG in aortic root replacement due to non-viable coronary buttons significantly increases patient morbidity and mortality, with the majority of patients left open, needing significant blood product transfusion, requiring adjunctive mechanical circulatory support, and ultimately leading to in-hospital mortality.
Advances in aortic root replacement substitutes and surgical technique have significantly improved outcomes. However, re-implantation of the coronaries can carry significant risk when the coronary buttons are of poor quality, potentially compromising cardiac function due to malperfusion. Prior studies have suggested that when re-do root replacement is performed, unplanned CABG increases mortality, but no study has focused solely on comparing the two groups regardless of prior procedure. We compared patients who underwent aortic root replacement with concomitant coronary artery bypass grafting (CABG) at our institution, reviewing their pre-operative and operative characteristics, and subsequent outcomes.
Methods
We reviewed aortic root replacements with simultaneous CABG at our institution from 2011-2023 using our prospectively maintained retrospective database. Patients were stratified into two cohorts based on whether the CABG was unplanned or planned. In total, 33 patients were identified that underwent root replacement with concomitant CABG.
Results
In total, 11 CABG were unplanned, and 22 were planned. In all unplanned cases, the CABG was performed due to poor quality of the coronary button. Seven unplanned patients required mechanical circulatory support, compared to one planned patient (p=0.006). Cardiopulmonary bypass (p=0.001) and circulatory arrest (p=0.33) when an adjunctive aortic procedure was performed were significantly higher in the unplanned group. Intraoperative RBC (p=0.039) and FFP (p=0.007) administration was higher in the unplanned group, with most patients left with an open chest (p<0.001). Post-operatively, unplanned CABG patients required prolonged ventilation (p=0.003), and most patients died during their hospitalization (p=0.018).
Conclusion
Unplanned CABG in aortic root replacement due to non-viable coronary buttons significantly increases patient morbidity and mortality, with the majority of patients left open, needing significant blood product transfusion, requiring adjunctive mechanical circulatory support, and ultimately leading to in-hospital mortality.
Aortic Symposium:
Aortic Root
Image or Table
