2. Concomitant Coronary Artery Bypass Grafting in Acute Type A Aortic Dissection
Presented During: Evolving Controversies in Acute Type A Dissection
Johns Hopkins Univerity
Baltimore, MD
United States - Contact Me
Jennifer S. Lawton, MD, is the Richard B. Darnall Professor of Surgery, Chief of the Division of Cardiac Surgery, Director of Cardiac Surgery Research Laboratory, and Cardiac Surgeon – in – Charge, Johns Hopkins University and Hospital.
Deutsches Herzzentrum der Charité
Berlin, Germany
Germany - Contact Me
Resident in Cardiac Surgery at the German Heart Center Charité in Berlin.
Research focus in aortic diseases.
Saturday, May 6, 2023: 8:30 AM - 8:45 AM
15 Minutes
Los Angeles Convention Center
Room: 515B
Description
Objective: Concomitant coronary artery bypass grafting (CABG) is infrequently performed during surgery for acute type A aortic dissection (ATAAD), therefore available data are scarce. Aim of this study is to investigate the outcomes of this subgroup from a single-center experience.
Methods: 169 patients underwent concomitant CABG during surgical treatment for ATAAD between 01/2000 and 12/2021. Patients with iatrogenic dissections (n=63), reimplantation of old bypass grafts (n=4), chronical dissections (n=4) and missing data (n=1) were excluded. After descriptive analysis of the cohort, a multivariable binary logistic regression analysis based on multiple stepwise regression was performed to identify independent risk factors for thirty-day mortality.
Results: 97 patients were enrolled in this study. Indications for CABG were coronary dissection (n=66; 69%) and/or primary coronary artery disease (n=31; 32%). Preoperative coronary malperfusion was present in 70% of patients (n=68). The right coronary artery (RCA) was the most frequently revascularized vessel (n=78; 80%), followed by left anterior descending artery (LAD) (n=34; 35%). Revascularization of the RCA was mainly performed in the setting of coronary dissection (p<0.001), whereas the LAD was treated mainly in cases of coronary artery disease (p=0.019). Post-cardiopulmonary bypass right heart failure was present in 22 patients (21%) and 27 patients (28%) received postoperative mechanical circulatory support. Thirty-day mortality was 43% (n=42) and rate of new postoperative stroke 13% (n=13). In terms of solely coronary dissection (n=56), thirty-day mortality was almost twice as high (50% vs. 27%) as in cases of solely coronary artery disease (n=30) but did not differ significantly (p=0.063). Mean survival was 3.7 years (median=162 days). Follow up reached up to 20 years according to the operation date. Multivariable analysis identified preoperative coronary malperfusion (p=0.022), left ventricular dysfunction (p=0.016), cardiopulmonary bypass time (p=0.005), bypass grafting of the LAD (p=0.013), coronary dissection (p=0.020) and post-cardiopulmonary bypass right heart failure (p=0.005) as independent risk factors for thirty-day mortality.
Conclusions: Patients who require concomitant CABG during surgery for ATAAD are subject to high perioperative morbidity and mortality. Signs of coronary malperfusion on admission, coronary dissection and prolonged cardiopulmonary bypass time impact outcomes.
Methods: 169 patients underwent concomitant CABG during surgical treatment for ATAAD between 01/2000 and 12/2021. Patients with iatrogenic dissections (n=63), reimplantation of old bypass grafts (n=4), chronical dissections (n=4) and missing data (n=1) were excluded. After descriptive analysis of the cohort, a multivariable binary logistic regression analysis based on multiple stepwise regression was performed to identify independent risk factors for thirty-day mortality.
Results: 97 patients were enrolled in this study. Indications for CABG were coronary dissection (n=66; 69%) and/or primary coronary artery disease (n=31; 32%). Preoperative coronary malperfusion was present in 70% of patients (n=68). The right coronary artery (RCA) was the most frequently revascularized vessel (n=78; 80%), followed by left anterior descending artery (LAD) (n=34; 35%). Revascularization of the RCA was mainly performed in the setting of coronary dissection (p<0.001), whereas the LAD was treated mainly in cases of coronary artery disease (p=0.019). Post-cardiopulmonary bypass right heart failure was present in 22 patients (21%) and 27 patients (28%) received postoperative mechanical circulatory support. Thirty-day mortality was 43% (n=42) and rate of new postoperative stroke 13% (n=13). In terms of solely coronary dissection (n=56), thirty-day mortality was almost twice as high (50% vs. 27%) as in cases of solely coronary artery disease (n=30) but did not differ significantly (p=0.063). Mean survival was 3.7 years (median=162 days). Follow up reached up to 20 years according to the operation date. Multivariable analysis identified preoperative coronary malperfusion (p=0.022), left ventricular dysfunction (p=0.016), cardiopulmonary bypass time (p=0.005), bypass grafting of the LAD (p=0.013), coronary dissection (p=0.020) and post-cardiopulmonary bypass right heart failure (p=0.005) as independent risk factors for thirty-day mortality.
Conclusions: Patients who require concomitant CABG during surgery for ATAAD are subject to high perioperative morbidity and mortality. Signs of coronary malperfusion on admission, coronary dissection and prolonged cardiopulmonary bypass time impact outcomes.
Presentation Duration
7 minute presentation; 7 minute discussion