Mid-term Outcomes of Ascending Aortic Aneurysm Repair with Coronary Artery Bypass Grafting

P0211 

Abstract Submission 

Shiv Verma (1), Wei-Guo Ma (1), Nupur Nagarkatti (2), Ely Erez (1), Adrian Acuna Higaki (2), Roland Assi (2), Prashanth Vallabhajosyula (1)

(1) Yale New Haven Hospital, New Haven, CT, (2) Yale University School of Medicine, New Haven, CT

Shiv Verma    -  Contact Me
Yale New Haven Hospital

Wei-Guo Ma    -  Contact Me
Yale New Haven Hospital

Nupur Nagarkatti    -  Contact Me
Yale University School of Medicine

Ely Erez    -  Contact Me
Yale New Haven Hospital

Adrian Acuna Higaki    -  Contact Me
Yale University School of Medicine

Roland Assi    -  Contact Me
Yale University School of Medicine

*Prashanth Vallabhajosyula    -  Contact Me
Yale New Haven Hospital

Shiv Verma    -  Contact Me
N/A

Objective: To evaluate if concomitant CABG for coronary artery disease (CAD) during ascending aortic aneurysm (AsAA) repair is associated with worse early and mid-term outcomes compared to isolated AsAA repair.

Methods: A single-center, retrospective cohort study was performed with 69 patients out of 248 who underwent AsAA repair from February 2020 to December 2022. We analyzed clinical data and outcomes for a matched cohort of 35 patients who received a concomitant CABG for confirmed CAD (involving 1, 2, and 3 vessels in 17, 11, and 7 patients, respectively) and 34 who received isolated AsAA repair.

Results: Mean age was 64.8±7.7 years (59 male, 85.5%). Hypertension was seen in 53 patients (76.8%), bicuspid aortic valve in 29 (42%), dyslipidemia in 47 (68.1%), atrial fibrillation in 8 (11.6%), and chronic kidney injury in 7 (10.1%). AsAA involved the ascending aorta (AAo) in 25 patients (36.2%), root+AAo in 31 (44.9%), AAo+arch in 7 (10.1%), and root+AAo+arch in 4 (5.8%). Mean AsAA diameter was 47.1±4.9mm.

The two groups were similar at baseline except for lower triglyceride levels (109±47 vs 134±60 mg/dL, p=.053) and less antiplatelet use (35.3% vs 62.9%, p=.022) in isolated AsAA patients. Left internal mammary artery (LIMA) graft was used in 18 patients and saphenous vein graft in 30, while hypothermic circulatory arrest was used in 59 patients (85.5%). Although CABG significantly prolonged cardiopulmonary bypass (304 vs 259 m, p=.027) and cross-clamp times (230 vs 174 m, p=.003), no operative deaths occurred in either group (0 vs 0, p=1.000), nor did the two groups differ significantly in terms of intubation time, need for blood transfusion, IABP use, stroke, acute kidney injury, reexploration for bleeding, or length of ICU stay (Table 1).

There were 2 deaths and 3 reinterventions during follow-up, which was 100% complete at 2.3±0.9 years (range 0.3-4.1). In the CABG group, 1 patient died from sternal wound abscess at 4 months and another from COVID-19 pneumonia at 2 years. 3 patients in the isolated AsAA group underwent TEVAR for type B dissection at 3.3, 4.2, and 18.4 months. For the whole series, survival was 98.6% (95% confidence interval [CI], 91.2-99.8%) at 1 year and 96.4% (95% CI, 85.9-99.1%) at 3 years, and freedom from reintervention was 97.1% (95% CI, 88.9-99.3%) at 1 year and 93.6% (95% CI, 79.5-98.1%) at 3 years. Neither survival nor freedom from reintervention differed significantly between patients with and without CABG (93.1% vs 100%, p=.174; 94.3% vs 100%%, p=.101, respectively) (Figures 2 and 3).

Conclusion: In this series of patients with AsAA, a concomitant CABG for coexisting CAD was not associated with increased risks for operative mortality and morbidities and achieved mid-term survival and freedom from reoperation comparable to isolated AsAA repair. These results suggest that CABG can be safely performed during AsAA repair when necessary.

Ascending Aorta