title: Impact of concomitant coronary artery bypass grafting on hospital survival after aortic root replacement.
abstract: BACKGROUND
  We examined the impact of concomitant coronary artery bypass grafting (CABG) on hospital survival after aortic root replacement. We sought to determine whether CABG procedures that were not originally planned but rather added after the aortic root procedure was completed (CABG/bailout) skewed the results to shift patients with bad outcomes to the CABG group, making the non-CABG group appear undeservedly low risk.
  
  
  METHODS
  Between May 1992 and January 2001, 369 consecutive patients underwent aortic root replacement. Concomitant CABG was required in 95 patients (26%). Indications for CABG were significant coronary artery disease in 73 patients (20%), active endocarditis or acute aortic dissection involving the coronary orifices in 14 patients (4%), and difficulty weaning from bypass because of regional wall motion abnormality from presumed but unconfirmed coronary artery disease or technical error at coronary ostial reimplantation (CABG/bailout) in 8 patients (2%).
  
  
  RESULTS
  Operative mortality for the entire cohort was 5.7% (21 patients). The operative mortality rate for the non-CABG group was 0.4% (1 of 274 patients), and for the CABG group, 21% (20 of 95 patients; p < 0.001). Independent predictors of operative mortality in the CABG group were New York Heart Association functional class III or IV (odds ratio, 3.9; 95% confidence interval, 1.07 to 14.5), active endocarditis (odds ratio, 9.2; 95% confidence interval, 2.06 to 41.5), acute aortic dissection (odds ratio, 7.6; 95% confidence interval, 1.81 to 32.0), and failure to use retrograde cardioplegia (odds ratio, 6.4; 95% confidence interval, 1.06 to 38.8). The use of CABG/bailout was not a predictor.
  
  
  CONCLUSIONS
  Adding CABG at the end of an aortic root procedure is a rare event, and because it is rare, there is no significant shift of risk as a result of the CABG/bailout patients on the overall CABG group.
authors.affiliation: Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA. jbyrne@partners.org
authors.forename: John G
authors.initials: JG
authors.lastname: Byrne
authors.forename: Alexandros N
authors.initials: AN
authors.lastname: Karavas
authors.forename: Marzia
authors.initials: M
authors.lastname: Leacche
authors.forename: Daniel
authors.initials: D
authors.lastname: Unic
authors.forename: James D
authors.initials: JD
authors.lastname: Rawn
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Couper
authors.forename: Tomislav
authors.initials: T
authors.lastname: Mihaljevic
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Rizzo
authors.forename: Sary F
authors.initials: SF
authors.lastname: Aranki
authors.forename: Lawrence H
authors.initials: LH
authors.lastname: Cohn
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000473:pathology / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000453:epidemiology / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000453:epidemiology / Q000601:surgery; D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000401:mortality / Q000706:statistics & numerical data*; D003331:Coronary Vessels / Q000637:transplantation; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D018570:Risk Assessment; D016019:Survival Analysis