Simultaneous Coronary Artery Bypass and Acute Type A Aortic Dissection Repair

Background: The necessity for coronary artery bypass grafting during the repair of acute type A aortic dissection is not uncommon and remains associated with high mortality rates. However, the indications, characteristics, and predictors of in-hospital mortality in these patients require further clarification.

Methods: All patients in our center who underwent a concomitant coronary artery bypass grafting and acute type aortic dissection repair between March 2007 and June 2023 were included in our study. Descriptive statistics were used to analyze indications, location, and outcomes of concomitant CABG and comparative statistics to compare preoperative, intraoperative, and postoperative variables between two subgroups: Group A (patients survived hospital stay) and Group B (patients died in hospital). In addition, a blinded independent review of all preoperative computed tomography examination by radiologist experienced in cardiovascular imaging was conducted to identify patients with possible coronary involvement.

Results: Ninety-eight patients underwent surgery for acute type A aortic dissection with simultaneous coronary artery bypass grafting. The right coronary artery was the most commonly grafted vessel, accounting for 57% of cases. CABG was indicated due to coronary artery dissection in 40% of cases. The in-hospital mortality rate was 26.5%. Evaluation of CT examinations identified coronary involvement in 62% of cases, whereas intraoperative findings revealed coronary dissection in only 40% of patients. Preoperative high levels of creatine kinase-MB (CK-MB) were significantly higher in Group B (82 [IQR 34, 249]) compared with Group A (52 [IQR 13, 178]); high levels of CK-MB were identified as a predictor of in-hospital mortality.

Conclusion: A thorough examination of preoperative laboratory values, identification of ECG abnormalities, and careful evaluation of preoperative CT scans can help to identify patients with coronary malperfusion. This allows the surgical team to implement the most appropriate strategies to achieve optimal outcomes in this high-risk patient group.

Publication History

Article published online:
11 February 2025