Aortic arch repair with coronary artery revascularization.
OBJECTIVE
Simultaneous aortic arch repair and coronary artery bypass are associated with considerable morbidity and mortality. We retrospectively analyzed our experience with on- and off-pump coronary artery bypass (CAB) combined with aortic arch repair.


METHODS
Before aortic arch repair, distal coronary artery anastomosis was constructed on the arrested heart under CAB (ONCAB: n=14), or on the beating heart before CAB (OPCAB: n=18). We also analyzed data from patients after isolated total arch replacement (TAR: n=20).


RESULTS
Compared with ONCAB, OPCAB was associated with shorter periods of myocardial ischemia (133 +/- 24 vs. 180 +/- 48 min, P = 0.017) and cardiopulmonary bypass (239 +/- 35 vs. 306 +/- 61 min, P = 0.002), less prolonged postoperative ventilation (33% vs. 79%, P = 0.027) and lower postoperative peak CK-MB levels (35 +/- 19 vs. 99 +/- 124 U/L, P = 0.012). One (6%) patient after OPCAB and 3 (21%) after ONCAB (P = 0.210) died in hospital. Compared with the TAR group, the myocardial ischemic periods after OPCAB (125 +/- 30 vs. 133 +/- 24 min, P = 0.401) and postoperative outcomes were similar.


CONCLUSIONS
Aortic arch repair with OPCAB offers an option for treating aortic arch aneurysm accompanied by atherosclerotic coronary artery disease.
Wakamatsu
Hiroki
H
Department of Cardiovascular Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan. hitoshiy@fmu.ac.jp
Sato
Yoichi
Y
Takase
Shinya
S
Sato
Yoshiyuki
Y
Satokawa
Hirono
H
Yokoyama
Hitoshi
H
D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery; D001026:Coronary Artery Bypass; D047549:Coronary Artery Bypass, Off-Pump; D003324:Coronary Artery Disease / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies