P240. Outcomes and Risk in Proximal Aortic Replacement with Concomitant Coronary Artery Bypass Grafting
Presented During: POD Abstracts (Available for viewing in the exhibit hall for the duration of the meeting)
Baylor St Lukes/Texas Heart Institute
Houston, TX
United States - Contact Me
Dr. Barron is a cardiothoracic surgery Assistant Professor at Baylor College of Medicine and Texas Heart Institute. She earned her bachelor’s degree at Hawai’i Pacific University and her medical degree from Texas A&M before moving to St. Louis for general surgery residency at Washington University. She spent three years as a Ruth Kirschstein NRSA research fellow working in basic and translational research before completing residency in 2020 and cardiothoracic fellowship in 2022.
Thursday, April 25, 2024: 5:38 PM - 7:00 PM
Sheraton Times Square
Room: Central Park
Description
Objective: Proximal aortic repair is often performed in patients with significant coronary artery disease that is addressed to mitigate prohibitive risk. We analyzed proximal aortic repair with and without concomitant coronary artery bypass grafting (CABG) to understand risk factors and operative outcomes.
Methods: We retrospectively reviewed 3916 patients (median age 62 years [38-70]) who underwent proximal aortic repair (1990-2022), including 717 (18.3%) who underwent concomitant CABG (+CABG). Propensity score matching was used to adjust for baseline differences between repairs with and without +CABG. Logistic regression aimed to identify predictors of operative death (death within 30 days or before final hospital discharge including transfer) and adverse events (a composite of operative death, persistent neurological deficit, or persistent renal failure necessitating hemodialysis). Kaplan-Meier analyzed survival was compared by log-rank.
Results: Patients in the +CABG group were older (67 years vs 60 years [p<.001]), more likely to be male (73.5% vs 66.5% [p=.002]), and more likely to have chronic kidney disease (36.9% vs 23.1% [p<.001]) than those without +CABG (Table 1). Overall, patients in the +CABG group had a higher occurrence of operative death and adverse events (13.4% vs 7.7% and 18.1% vs 10.9% [p<.001]); after matching (520 pairs), operative mortality was similar, although the +CABG group had higher rates of adverse events (16.5% vs 11.9% [p=.03]), including persistent renal failure (9.2% vs 5.6% [p=.02]). Concomitant CABG was an independent predictor of adverse events (OR=1.63, p=.009) in the overall cohort but lost significance after matching (p=.09). Late survival was significantly decreased in patients with concomitant CABG (overall cohort, 35.0% vs 54.1% at 10 years, p<.001; matched cohort, 35.3% vs 46.2% at 10 years, p=.006). Of interest, late survival was not affected by the number of bypasses performed (p=.3).
Conclusion: Patients who underwent concomitant CABG experienced adverse events more frequently than those who did not; however, +CABG was not an independent predictor of adverse events. Patients who required CABG were older and had more co-morbid conditions. Long-term survival was significantly decreased in +CABG patients. Findings suggest that patients who require concomitant CABG are more medically fragile, and they may benefit from close postoperative follow-up focused on the management of non-aortic related comorbidities.
Authors
Lauren Barron (1), Natalia Roa-Vidal (2), Kimberly Rebello (3), Qianzi Zhang (3), Susan Green (4), Scott A. LeMaire (5), Marc Moon (1), Joseph Coselli (6)
Institutions
(1) Baylor College of Medicine / Texas Heart Institute, Houston, TX, (2) School of Medicine, University of Puerto Rico Medical Science Campus, San Juan, PR, (3) Baylor College of Medicine, Houston, TX, (4) N/A, Houston, TX, (5) Geisinger Commonwealth School of Medicine, Scranton, PA, (6) Baylor College of Medicine, Texas Heart Institute, United States
Methods: We retrospectively reviewed 3916 patients (median age 62 years [38-70]) who underwent proximal aortic repair (1990-2022), including 717 (18.3%) who underwent concomitant CABG (+CABG). Propensity score matching was used to adjust for baseline differences between repairs with and without +CABG. Logistic regression aimed to identify predictors of operative death (death within 30 days or before final hospital discharge including transfer) and adverse events (a composite of operative death, persistent neurological deficit, or persistent renal failure necessitating hemodialysis). Kaplan-Meier analyzed survival was compared by log-rank.
Results: Patients in the +CABG group were older (67 years vs 60 years [p<.001]), more likely to be male (73.5% vs 66.5% [p=.002]), and more likely to have chronic kidney disease (36.9% vs 23.1% [p<.001]) than those without +CABG (Table 1). Overall, patients in the +CABG group had a higher occurrence of operative death and adverse events (13.4% vs 7.7% and 18.1% vs 10.9% [p<.001]); after matching (520 pairs), operative mortality was similar, although the +CABG group had higher rates of adverse events (16.5% vs 11.9% [p=.03]), including persistent renal failure (9.2% vs 5.6% [p=.02]). Concomitant CABG was an independent predictor of adverse events (OR=1.63, p=.009) in the overall cohort but lost significance after matching (p=.09). Late survival was significantly decreased in patients with concomitant CABG (overall cohort, 35.0% vs 54.1% at 10 years, p<.001; matched cohort, 35.3% vs 46.2% at 10 years, p=.006). Of interest, late survival was not affected by the number of bypasses performed (p=.3).
Conclusion: Patients who underwent concomitant CABG experienced adverse events more frequently than those who did not; however, +CABG was not an independent predictor of adverse events. Patients who required CABG were older and had more co-morbid conditions. Long-term survival was significantly decreased in +CABG patients. Findings suggest that patients who require concomitant CABG are more medically fragile, and they may benefit from close postoperative follow-up focused on the management of non-aortic related comorbidities.
Authors
Lauren Barron (1), Natalia Roa-Vidal (2), Kimberly Rebello (3), Qianzi Zhang (3), Susan Green (4), Scott A. LeMaire (5), Marc Moon (1), Joseph Coselli (6)
Institutions
(1) Baylor College of Medicine / Texas Heart Institute, Houston, TX, (2) School of Medicine, University of Puerto Rico Medical Science Campus, San Juan, PR, (3) Baylor College of Medicine, Houston, TX, (4) N/A, Houston, TX, (5) Geisinger Commonwealth School of Medicine, Scranton, PA, (6) Baylor College of Medicine, Texas Heart Institute, United States
Presentation Duration
PODS will be on display in the exhibit hall for the duration of the meeting during exhibit hall hours. PODS will also be available for viewing on the meeting website. There is no formal presentation associated with your POD, but we encourage you to visit the PODS area during breaks to connect with those viewing.