Short and midterm outcomes of elective total aortic arch replacement combined with coronary artery bypass grafting.
BACKGROUND
This study was performed to investigate the early and late outcomes of total aortic arch replacement (TAR) with or without coronary artery bypass grafting (CABG).


METHODS
From October 1999 to December 2010, 200 consecutive patients underwent elective TAR for nondissecting aneurysm through a median sternotomy. Of this number, 131 (65.5%) had isolated TAR (TAR group) and 69 (34.5%) underwent concomitant CABG (TAR/CABG group). Patients in the TAR/CABG group were older and had more advanced chronic kidney disease and higher additive/logistic European System for Cardiac Operative Risk Evaluation and Japan scores than patients in the TAR group.


RESULTS
Overall 30-day mortality was 0.5% (1 of 200) and hospital mortality was 3.5% (7 of 200). Hospital mortality was 1.5% (2 of 131) in the TAR group and 7.2% (5 of 69) in the TAR/CABG group (p=0.036). Multivariate analysis showed that operation time (odds ratio [OR] 1.01, p=0.013) was a risk factor for hospital mortality, but failed to demonstrate concomitant CABG as a risk factor. Cox proportional hazard analysis showed that age (OR 1.08, p=0.05), female sex (OR 3.58, p=0.0004), chronic kidney disease (OR 7.70, p<0.0001), and operation time (OR 1.01, p=0.0002) were risk factors for midterm mortality, whereas concomitant CABG was not (OR 0.92, p=0.87). There was a significant difference in midterm survival and freedom from major cerebrocardiovascular events in the TAR group versus the TAR/CABG group.


CONCLUSIONS
Concomitant CABG was not a risk factor for hospital morality with TAR. However, patients with concomitant CABG have more preoperative comorbidities, which may adversely affect outcomes, and which may therefore deserve special attention.
Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Kenji
K
Okada
Atsushi
A
Omura
Hiroya
H
Kano
Taimi
T
Ohara
Tomonori
T
Shirasaka
Katsuhiro
K
Yamanaka
Shunsuke
S
Miyahara
Toshihito
T
Sakamoto
Akiko
A
Tanaka
Takeshi
T
Inoue
Takanori
T
Oka
Hitoshi
H
Minami
Yutaka
Y
Okita
D000368:Aged; D001013:Aorta, Thoracic / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000150:complications* / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000150:complications* / Q000601:surgery*; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome