Impact of concomitant coronary artery bypass grafting on the outcomes of total arch repair with frozen elephant trunk for type A aortic dissection.

Autor:	Huang LC; Department of Vascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China., Zhang AK; Department of Cardiology, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China., Hu XM; Department of Cardiology, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China., Shao ZH; Department of Vascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China., Sun YX; Department of Vascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China., Zhao D; Department of Vascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China., Chang Y; Department of Vascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China., Qian XY; Department of Vascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China., Guo HW; Department of Vascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Jazyk:	angličtina
Zdroj:	European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery [Eur J Cardiothorac Surg] 2024 Nov 28; Vol. 66 (6).
DOI:	10.1093/ejcts/ezae445
Abstrakt:	Objectives: Coronary artery bypass grafting (CABG) is often performed alongside type A aortic dissection (TAAD) repair. However, the association between concomitant CABG and the clinical outcomes of TAAD repair remains uncertain. Methods: This study included 1002 consecutive TAAD patients who underwent total aortic arch replacement (TAR) with frozen elephant trunk from June 2019 to January 2024. Concomitant CABG during TAR and frozen elephant trunk was performed under 3 conditions: planned CABG for coronary ostial involvement, planned CABG for coronary artery disease and rescue CABG. Patients who underwent rescue CABG (N = 42) were compared with those who had planned CABG (N = 218) and those who did not undergo CABG (non-CABG: N = 742). Logistic regression, Kaplan-Meier and Cox regression analyses were employed. Results: Operative mortality rate was 2.40%; 42 (4.19%) patients underwent rescue CABG. The rescue CABG group had the highest operative mortality (23.81%) among the 3 groups (P < 0.001). Rescue CABG was associated with increased operative mortality compared with non-CABG [odds ratio: 18.96, 95% confidence interval (CI) 7.32-49.08, P < 0.001], whereas planned CABG was not significant. The median follow-up period was 24.80 (interquartile range 11.73-39.10) months. Kaplan-Meier analysis demonstrated poorer overall survival in the rescue CABG group (log-rank P-value < 0.001). Rescue CABG significantly increased all-cause late mortality compared with non-CABG (hazard ratio 13.69, 95% CI 6.53-28.70, P < 0.001), while planned CABG did not. The 2-year cumulative incidence of graft occlusion among CABG patients was 24.54%. Conclusions: Rescue CABG is significantly associated with increased operative and all-cause mortality in patients undergoing TAR and frozen elephant trunk for TAAD. Further research is required to identify the causes of rescue CABG. (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)
Databáze:	MEDLINE
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