Concomitant Coronary Artery Bypass Graft with Thoracic Aortic Aneurysm Repair Increases Risk of Stroke, Operative, and Long-Term Mortality

P0090 

Abstract Submission 

Yaagnik Kosuri (1), Kavya Rajesh (2), Morgan Moroi (3), Krushang Patel (2), Pengchen Wang (4), Yu Hohri (5), Paul Kurlansky, MD (6), Craig Smith (7), Hiroo Takayama (8)

(1) New York Presbyterian/Columbia, New York, NY, (2) N/A, N/A, (3) N/A, United States, (4) Center for Innovation and Outcomes Research, Department of Surgery, Columbia University, New York, NY, (5) Columbia University Irving Medical Center, New York, NY, (6) Columbia University Medical Center, New York, NY, (7) Columbia University Irving Medical Center of New York Presbyterian Hospital, New York, NY, (8) NewYork- Presbyterian/Columbia University Medical Center, New York, NY

Yaagnik Kosuri    -  Contact Me
New York Presbyterian/Columbia

Kavya Rajesh    -  Contact Me
N/A

Morgan Moroi    -  Contact Me
N/A

Krushang Patel    -  Contact Me
N/A

Pengchen Wang    -  Contact Me
Center for Innovation and Outcomes Research, Department of Surgery, Columbia University

Yu Hohri    -  Contact Me
Columbia University Irving Medical Center

*Paul Kurlansky, MD    -  Contact Me
Columbia University Medical Center

*Craig Smith    -  Contact Me
Columbia University Irving Medical Center of New York Presbyterian Hospital

*Hiroo Takayama    -  Contact Me
NewYork- Presbyterian/Columbia University Medical Center

Yaagnik Kosuri    -  Contact Me
New York Presbyterian/Columbia

OBJECTIVE: This single-center retrospective study aims to 1) ascertain the added risk of performing coronary artery bypass graft (CABG) when the primary indication for open surgery is aortic aneurysm repair and 2) determine the difference in outcomes when the primary indication for combined surgery is aortic versus coronary artery disease (CAD).
METHODS: Patients who underwent open thoracic aortic replacement with or without concomitant CABG from 2005-2020 were included. Cases of emergent CABG were excluded. In the first analysis, 1391 patients for whom the primary indication for surgery was aortic disease alone were split into two groups: 1) those who underwent aortic replacement alone (aneurysm, n=1210) and 2) those who underwent aortic replacement with concomitant CABG (aneurysm/CABG, n=181) (Figure 1A). Inverse probability treatment weighting (IPTW) was performed to adjust for baseline differences between groups. Multivariable regression using the IPTW cohort was used to study postoperative complications, including stroke, respiratory failure, renal failure, and reoperation for bleeding. Kaplan-Meier (KM) analysis was used to study long-term mortality in the matched cohort. In our secondary analysis, all patients undergoing both aortic replacement and CABG (n=220) were split by primary indication for operation, aortic disease (n=181) or CAD (n=39). Similarly, perioperative complications and long-term mortality were studied.
RESULTS: After IPTW, compared to the group that had aortic replacement alone, the CABG/aneurysm group had increased stroke rate (OR: 2.36, 1.23-4.27, p=.006), post operative respiratory failure (OR: 2.83, 1.79-4.40, p<.0001), and operative mortality (OR: 2.59, 1.18-5.28, p=.001). Both groups had similar extent of aortic replacement (root, ascending, or arch, p = 0.4). KM curve for the matched cohort censored at 9 years showed decreased survival probability for aneurysm/CABG group (p = 0.002) . In the secondary analysis in aneurysm/CABG group, indication (aneurysm (n=181) vs CAD (n=39)) was not significant for postoperative morbidity or mortality with no significant difference in 9-year mortality (p = 0.8).
CONCLUSION: When performing open thoracic aortic replacement, the addition of CABG confers an added risk of stroke, post operative respiratory failure, and long-term mortality. Outcomes for combined surgery are similar regardless of primary indication.

Aortic Arch