Division of Cardiothoracic Surgery, Emory University, Atlanta, Georgia.
Department of Anesthesiology, Duke University, Durham, North Carolina.
Ann Thorac Surg. 2018 Dec;106(6):1727-1734. doi: 10.1016/j.athoracsur.2018.06.079. Epub 2018 Aug 29.
Aortic root replacement (ROOT) has been an established therapy, yet the impact of adding coronary artery bypass grafting (CABG) to ROOT (CABG-R) is unknown. The purpose of this research was to investigate the impact of CABG on the outcomes of ROOT.
A retrospective review from 2004 to 2016 of patients undergoing nonemergent ROOT surgical procedure was performed. Cohorts were established based on the presence or absence of added CABG. A propensity-score weighted comparison of outcomes was then conducted.
A total of 867 patients met inclusion criteria and were analyzed (711 ROOT [72.0%], 156 CABG-R [18.0%]). CABG-R patients were older and had higher proportions of previous valve operation, hypertension, endocarditis, immunosuppressive therapy, renal insufficiency, and redo operation (all p < 0.01). Indications for CABG included anatomy (n = 48, 30.8%), coronary artery disease (80, 51.3%), and ventricular failure (28, 17.9%). The permanent stroke rate was not significantly increased with the addition of CABG-R (p = 0.06). Thirty-day mortality was 5.5% for the entire cohort but was substantially higher in patients who underwent concomitant CABG (3.4% ROOT, 15.4% CABG-R). Mortality rates were highest among patients with acute ventricular failure and CABG (28.8%) compared with patients who underwent CABG for coronary artery disease (6.3%) or patients for anatomy (22.9%; p = 0.003).
CABG-R results in increased postoperative morbidity or mortality compared with isolated ROOT. Outcomes, however, are influenced by the specific clinical indication. CABG for coronary artery disease was associated with similar outcomes compared with isolated ROOT. Patients undergoing unplanned CABG for acute ventricular failure had the worst outcomes, thus underscoring the importance of technical success during coronary reimplantation.
主动脉根部置换术（ROOT）已成为一种既定的治疗方法，但在 ROOT 中添加冠状动脉旁路移植术（CABG）的影响尚不清楚。本研究旨在探讨 CABG 对 ROOT 结果的影响。
对 2004 年至 2016 年期间接受非紧急 ROOT 手术的患者进行回顾性研究。根据是否添加 CABG 建立队列。然后进行倾向评分加权比较结果。
共有 867 名符合纳入标准的患者进行了分析（711 例 ROOT [72.0%]，156 例 CABG-R [18.0%]）。CABG-R 患者年龄较大，且先前瓣膜手术、高血压、心内膜炎、免疫抑制治疗、肾功能不全和再次手术的比例较高（均 p < 0.01）。CABG 的适应证包括解剖学（n=48，30.8%）、冠状动脉疾病（80，51.3%）和心室衰竭（28，17.9%）。添加 CABG-R 并未显著增加永久性中风率（p=0.06）。整个队列的 30 天死亡率为 5.5%，但同时行 CABG 的患者死亡率明显更高（ROOT 为 3.4%，CABG-R 为 15.4%）。与行冠状动脉疾病 CABG（6.3%）或解剖学 CABG（22.9%）的患者相比，急性心室衰竭和 CABG 的患者死亡率最高（28.8%；p=0.003）。
与单独的 ROOT 相比，CABG-R 导致术后发病率或死亡率增加。然而，结果受到具体临床适应证的影响。与单独的 ROOT 相比，冠状动脉疾病的 CABG 与相似的结果相关。对于急性心室衰竭而行计划外 CABG 的患者预后最差，因此强调了在冠状动脉再植入过程中技术成功的重要性。
