P098. Destruction of the Button: Unplanned CABG in Aortic Root Replacement Significantly Increases Mortality
Presented During: POD Abstracts (Available for viewing in the exhibit hall for the duration of the meeting)
University of Colorado Anschutz
Denver, CO
United States - Contact Me
Adam Carroll is a current PGY-3 surgical resident at the University of Colorado. Adam attended medical school at the University of Colorado and has been involved in research with the cardiothoracic surgery department throughout medical school and residency. He has interest specifically in endovascular and transcatheter aortic interventions, as well as neurologic outcomes in aortic research. He is currently in the aortic surgery research labaratory in the Department of Cardiothoracic Surgery at the University of Colorado. He plans to pursue a career in cardiothoracic surgery following his general surgery residency.
Thursday, April 25, 2024: 5:38 PM - 7:00 PM
Sheraton Times Square
Room: Central Park
Description
Objective
Advances in aortic root replacement substitutes and surgical technique have significantly improved outcomes. However, re-implantation of the coronaries can carry significant risk when the coronary buttons are of poor quality, potentially compromising cardiac function due to malperfusion. Prior studies have suggested that when re-do root replacement is performed, unplanned CABG increases mortality, but no study has focused solely on comparing the two groups regardless of prior procedure. We compared patients who underwent aortic root replacement with concomitant coronary artery bypass grafting (CABG) at our institution, reviewing their pre-operative and operative characteristics, and subsequent outcomes.
Methods
We reviewed aortic root replacements with simultaneous CABG at our institution from 2011-2023 using our prospectively maintained retrospective database. Patients were stratified into two cohorts based on whether the CABG was unplanned or planned. In total, 33 patients were identified that underwent root replacement with concomitant CABG.
Results
In total, 11 CABG were unplanned, and 22 were planned. In all unplanned cases, the CABG was performed due to poor quality of the coronary button. Seven unplanned patients required mechanical circulatory support, compared to one planned patient (p=0.006). Cardiopulmonary bypass (p=0.001) and circulatory arrest (p=0.33) when an adjunctive aortic procedure was performed were significantly higher in the unplanned group. Intraoperative RBC (p=0.039) and FFP (p=0.007) administration was higher in the unplanned group, with most patients left with an open chest (p<0.001). Post-operatively, unplanned CABG patients required prolonged ventilation (p=0.003), and most patients died during their hospitalization (p=0.018).
Conclusion
Unplanned CABG in aortic root replacement due to non-viable coronary buttons significantly increases patient morbidity and mortality, with the majority of patients left open, needing significant blood product transfusion, requiring adjunctive mechanical circulatory support, and ultimately leading to in-hospital mortality.
Authors
Adam Carroll (1), Michael Kirsch (1), Nicolas Chanes (1), Bo Chang Wu (1), Muhammad Aftab (1), T. Brett Reece (1)
Institutions
(1) University of Colorado Anschutz, Denver, CO
Advances in aortic root replacement substitutes and surgical technique have significantly improved outcomes. However, re-implantation of the coronaries can carry significant risk when the coronary buttons are of poor quality, potentially compromising cardiac function due to malperfusion. Prior studies have suggested that when re-do root replacement is performed, unplanned CABG increases mortality, but no study has focused solely on comparing the two groups regardless of prior procedure. We compared patients who underwent aortic root replacement with concomitant coronary artery bypass grafting (CABG) at our institution, reviewing their pre-operative and operative characteristics, and subsequent outcomes.
Methods
We reviewed aortic root replacements with simultaneous CABG at our institution from 2011-2023 using our prospectively maintained retrospective database. Patients were stratified into two cohorts based on whether the CABG was unplanned or planned. In total, 33 patients were identified that underwent root replacement with concomitant CABG.
Results
In total, 11 CABG were unplanned, and 22 were planned. In all unplanned cases, the CABG was performed due to poor quality of the coronary button. Seven unplanned patients required mechanical circulatory support, compared to one planned patient (p=0.006). Cardiopulmonary bypass (p=0.001) and circulatory arrest (p=0.33) when an adjunctive aortic procedure was performed were significantly higher in the unplanned group. Intraoperative RBC (p=0.039) and FFP (p=0.007) administration was higher in the unplanned group, with most patients left with an open chest (p<0.001). Post-operatively, unplanned CABG patients required prolonged ventilation (p=0.003), and most patients died during their hospitalization (p=0.018).
Conclusion
Unplanned CABG in aortic root replacement due to non-viable coronary buttons significantly increases patient morbidity and mortality, with the majority of patients left open, needing significant blood product transfusion, requiring adjunctive mechanical circulatory support, and ultimately leading to in-hospital mortality.
Authors
Adam Carroll (1), Michael Kirsch (1), Nicolas Chanes (1), Bo Chang Wu (1), Muhammad Aftab (1), T. Brett Reece (1)
Institutions
(1) University of Colorado Anschutz, Denver, CO
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.