Department of Cardiac Surgery, University Hospital Zürich, Zürich, Switzerland; Evangelisches Klinikum Niederrhein, Duisburg, Germany.
Department of Cardiac Surgery, University Hospital Zürich, Zürich, Switzerland; Herzklinik Hirslanden, Zürich, Switzerland.
Semin Thorac Cardiovasc Surg. 2022 Summer;34(2):410-416. doi: 10.1053/j.semtcvs.2021.03.043. Epub 2021 May 10.
Coronary Artery Bypass Grafting (CABG) is sometimes necessary in acute Type A Aortic Dissection (AAAD) repair. The aim of this study is to analyze the incidence, indications and influence in-hospital outcomes of AAAD repair requiring concomitant CABG in a high-volume single-center experience. Retrospective study of all consecutive AAAD patients. Those who underwent concomitant CABG were identified. Preoperative, intraoperative, postoperative and follow-up data were collected and analyzed. Between January 1, 2010 and December 31, 2016, 382 patients underwent emergency surgery for AAAD. Forty-one (10.7%) underwent concomitant CABG. In this group, mean age was 64 ± 14 years, 32 were male (78%). Indication for CABG was coronary dissection in 28 patients (68.3%), post-cardiopulmonary bypass (CPB) right heart failure in 7 (17.1%), post CPB left heart failure in (7.3%) and native coronary pathology in 3 (7.3%). In 33 (80.5%) one graft was needed, in 7 (17%) two were performed and in 1 patient (2.4%) 3 were necessary. The right coronary artery (RCA) was the only revascularized vessel in 26 cases (63.4%), the left coronary artery (LCA) alone in 11 (26.8%), and both coronary systems in 4 (9.8%). In-hospital mortality was 51.2% (N = 21); eight (19.5%) patients had postoperative myocardial infarction (MI) and 11 (26.8%) had a major neurological event. Multivariable logistic regression identified concomitant CABG as a predictor of in-hospital mortality (Odds Ratio (OR) = 3.8115, 95% CI= 0.514-2.138, p = 0.001). In our study, concomitant CABG was performed in 10.7% of AAAD repair surgery and it was associated with high in-hospital mortality.
冠状动脉旁路移植术（CABG）在急性A型主动脉夹层（AAAD）修复中有时是必要的。本研究的目的是分析在大容量单一中心经验中，AAAD 修复中需要同时进行 CABG 的发生率、适应证和对住院结果的影响。回顾性分析所有连续的 AAAD 患者。确定同时进行 CABG 的患者。收集并分析术前、术中、术后和随访数据。2010 年 1 月 1 日至 2016 年 12 月 31 日，382 例 AAAD 患者行急诊手术。41 例（10.7%）同时行 CABG。在这组中，平均年龄为 64 ± 14 岁，32 例为男性（78%）。CABG 的适应证为 28 例（68.3%）冠状动脉夹层，7 例（17.1%）体外循环（CPB）后右心衰竭，7 例（7.3%）CPB 后左心衰竭，3 例（7.3%）为原发性冠状动脉病变。33 例（80.5%）需要 1 个移植物，7 例（17%）需要 2 个移植物，1 例（2.4%）需要 3 个移植物。26 例（63.4%）仅再血管化右冠状动脉（RCA），11 例（26.8%）仅再血管化左冠状动脉（LCA），4 例（9.8%）同时再血管化两个冠状动脉系统。住院期间死亡率为 51.2%（N=21）；8 例（19.5%）患者发生术后心肌梗死（MI），11 例（26.8%）发生重大神经系统事件。多变量逻辑回归将同时进行 CABG 确定为住院死亡率的预测因素（优势比（OR）=3.8115，95%CI=0.514-2.138，p=0.001）。在我们的研究中，AAAD 修复手术中同时进行 CABG 的比例为 10.7%，与住院死亡率高相关。
