P366. Unplanned Coronary Artery Bypass Graft in Aortic Root Replacement
Presented During: POD Abstracts (Available for viewing in the exhibit hall for the duration of the meeting)
NYPH-Columbia University Medical Center
New York, NY
United States - Contact Me
Kavya Rajesh is a fourth year medical student at the Columbia University Vagelos College of Physicians and Surgeons. She is interested in cardiothoracic surgery. Her research interests are in aortic and congential cardiac surgery. Kavya is from Austin, Texas and she graduated from the University of Texas at Austin with a degree in Chemistry.
Thursday, April 25, 2024: 5:38 PM - 7:00 PM
Sheraton Times Square
Room: Central Park
Description
Objective: Coronary artery bypass graft (CABG) may unexpectedly become necessary in aortic root replacement (ARR) for a variety of reasons, such as geometry of root, tissue friability, extent of dissection, injury during mobilization, myocardial ischemia due to coronary button trouble, or coronary button bleeding. This study aims to elucidate the outcomes of such unplanned CABG during ARR.
Methods: This is retrospective study from two large aortic centers who underwent ARR from 2004 to 2021. Planned CABG for atherosclerotic coronary artery disease were excluded (n=285) while other concomitant CABG were defined as "unplanned". A total of 2416 patients were divided into 2 groups based on the need of unplanned CABG: ARR (n=2212) vs ARR + Unplanned CABG (n=204). Propensity score matching (PSM) was performed to compare patients who underwent ARR or ARR + Unplanned CABG alongside landmark analysis to study long-term mortality. Multivariable logistic regression was used to determine which variables were associated with need for unplanned CABG. Results: Reasons for unplanned CABG included: 81 (3.4%) for anatomy or friability of coronary button, 33 (1.4%) for involvement of coronary ostia in aortic dissection, 12 (0.5%) for coronary injury during mobilization, and 78 (3.3%) for suspected impaired coronary flow at button anastomosis. ARR + Unplanned CABG had much higher in-hospital mortality (43 (21.1%) vs ARR 87 (3.9%), p<0.001). After PSM, in hospital mortality (42 (20.8%) vs 15 (7.4%), p<0.001), respiratory failure (99 (49.0%) vs 68 (33.7%), p=0.002), and renal failure (36 (17.8%) vs 21 (10.4%), p=0.045) were greater in the ARR + Unplanned CABG group compared to the ARR group, respectively (Figure 1a). Need for unplanned CABG was associated with following factors: urgent status (OR: 2.25, 95% CI [1.70-2.98], p <0.001), CKD (OR: 1.55, 95% CI [1.08-2.20], p = 0.01), reoperation (OR: 2.44, 95% CI [1.73-3.45], p <0.001), concomitant hemiarch replacement (OR: 1.47, 95% CI [1.07-2.03], p = 0.02), and valve-sparing root replacement (OR: 0.48, 95% CI [0.28-0.80], p=0.005). Landmark analysis showed decreased in survival probability up to 1 year in patients with ARR + Unplanned CABG compared to ARR (p<0.001) while survival was comparable among groups during the rest of the follow-up period (p=0.11) (Figure 1b).
Conclusions: Unplanned CABG leads to higher operative mortality in ARR. Patients who undergo ARR + Unplanned CABG have decreased survival probability during the first year after operation.
Authors
Kavya Rajesh (1), Megan Chung (2), Dov Levine (3), Yu Hohri (4), Elizabeth Norton (5), Parth Patel (5), Yanling Zhao (6), Paul Kurlansky, MD (7), Edward Chen (8), Hiroo Takayama (9)
Institutions
(1) N/A, N/A, (2) Columbia University Irving Medical Center, N/A, (3) Columbia University, New York, NY, (4) Columbia University Irving Medical Center, New York, NY, (5) Emory University, Atlanta, GA, (6) NewYork-Presbyterian Columbia University Irving Medical Center, New York, NY, (7) Columbia University Medical Center, New York, NY, (8) Duke University Medical Center, Durham, NC, (9) NewYork- Presbyterian/Columbia University Medical Center, New York, NY
Methods: This is retrospective study from two large aortic centers who underwent ARR from 2004 to 2021. Planned CABG for atherosclerotic coronary artery disease were excluded (n=285) while other concomitant CABG were defined as "unplanned". A total of 2416 patients were divided into 2 groups based on the need of unplanned CABG: ARR (n=2212) vs ARR + Unplanned CABG (n=204). Propensity score matching (PSM) was performed to compare patients who underwent ARR or ARR + Unplanned CABG alongside landmark analysis to study long-term mortality. Multivariable logistic regression was used to determine which variables were associated with need for unplanned CABG. Results: Reasons for unplanned CABG included: 81 (3.4%) for anatomy or friability of coronary button, 33 (1.4%) for involvement of coronary ostia in aortic dissection, 12 (0.5%) for coronary injury during mobilization, and 78 (3.3%) for suspected impaired coronary flow at button anastomosis. ARR + Unplanned CABG had much higher in-hospital mortality (43 (21.1%) vs ARR 87 (3.9%), p<0.001). After PSM, in hospital mortality (42 (20.8%) vs 15 (7.4%), p<0.001), respiratory failure (99 (49.0%) vs 68 (33.7%), p=0.002), and renal failure (36 (17.8%) vs 21 (10.4%), p=0.045) were greater in the ARR + Unplanned CABG group compared to the ARR group, respectively (Figure 1a). Need for unplanned CABG was associated with following factors: urgent status (OR: 2.25, 95% CI [1.70-2.98], p <0.001), CKD (OR: 1.55, 95% CI [1.08-2.20], p = 0.01), reoperation (OR: 2.44, 95% CI [1.73-3.45], p <0.001), concomitant hemiarch replacement (OR: 1.47, 95% CI [1.07-2.03], p = 0.02), and valve-sparing root replacement (OR: 0.48, 95% CI [0.28-0.80], p=0.005). Landmark analysis showed decreased in survival probability up to 1 year in patients with ARR + Unplanned CABG compared to ARR (p<0.001) while survival was comparable among groups during the rest of the follow-up period (p=0.11) (Figure 1b).
Conclusions: Unplanned CABG leads to higher operative mortality in ARR. Patients who undergo ARR + Unplanned CABG have decreased survival probability during the first year after operation.
Authors
Kavya Rajesh (1), Megan Chung (2), Dov Levine (3), Yu Hohri (4), Elizabeth Norton (5), Parth Patel (5), Yanling Zhao (6), Paul Kurlansky, MD (7), Edward Chen (8), Hiroo Takayama (9)
Institutions
(1) N/A, N/A, (2) Columbia University Irving Medical Center, N/A, (3) Columbia University, New York, NY, (4) Columbia University Irving Medical Center, New York, NY, (5) Emory University, Atlanta, GA, (6) NewYork-Presbyterian Columbia University Irving Medical Center, New York, NY, (7) Columbia University Medical Center, New York, NY, (8) Duke University Medical Center, Durham, NC, (9) NewYork- Presbyterian/Columbia University Medical Center, New York, NY
Presentation Duration
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