Huang Ling-Chen, Zhang Ai-Kai, Hu Xiang-Ming, Shao Ze-Hua, Sun Yang-Xue, Zhao Dong, Chang Yi, Qian Xiang-Yang, Guo Hong-Wei
Department of Vascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Cardiology, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Eur J Cardiothorac Surg. 2024 Nov 28;66(6). doi: 10.1093/ejcts/ezae445.
Coronary artery bypass grafting (CABG) is often performed alongside type A aortic dissection (TAAD) repair. However, the association between concomitant CABG and the clinical outcomes of TAAD repair remains uncertain.
This study included 1002 consecutive TAAD patients who underwent total aortic arch replacement (TAR) with frozen elephant trunk from June 2019 to January 2024. Concomitant CABG during TAR and frozen elephant trunk was performed under 3 conditions: planned CABG for coronary ostial involvement, planned CABG for coronary artery disease and rescue CABG. Patients who underwent rescue CABG (N = 42) were compared with those who had planned CABG (N = 218) and those who did not undergo CABG (non-CABG: N = 742). Logistic regression, Kaplan-Meier and Cox regression analyses were employed.
Operative mortality rate was 2.40%; 42 (4.19%) patients underwent rescue CABG. The rescue CABG group had the highest operative mortality (23.81%) among the 3 groups (P < 0.001). Rescue CABG was associated with increased operative mortality compared with non-CABG [odds ratio: 18.96, 95% confidence interval (CI) 7.32-49.08, P < 0.001], whereas planned CABG was not significant. The median follow-up period was 24.80 (interquartile range 11.73-39.10) months. Kaplan-Meier analysis demonstrated poorer overall survival in the rescue CABG group (log-rank P-value < 0.001). Rescue CABG significantly increased all-cause late mortality compared with non-CABG (hazard ratio 13.69, 95% CI 6.53-28.70, P < 0.001), while planned CABG did not. The 2-year cumulative incidence of graft occlusion among CABG patients was 24.54%.
Rescue CABG is significantly associated with increased operative and all-cause mortality in patients undergoing TAR and frozen elephant trunk for TAAD. Further research is required to identify the causes of rescue CABG.
冠状动脉旁路移植术（CABG）常与A型主动脉夹层（TAAD）修复术同时进行。然而，同期CABG与TAAD修复术临床结局之间的关联仍不明确。
本研究纳入了2019年6月至2024年1月期间连续1002例行带支架象鼻全主动脉弓置换术（TAR）的TAAD患者。在TAR和带支架象鼻手术期间同期行CABG的情况有3种：因冠状动脉开口受累而行计划性CABG、因冠状动脉疾病而行计划性CABG以及补救性CABG。将接受补救性CABG的患者（N = 42）与接受计划性CABG的患者（N = 218）以及未行CABG的患者（非CABG组：N = 742）进行比较。采用逻辑回归、Kaplan-Meier和Cox回归分析。
手术死亡率为2.40%；42例（4.19%）患者接受了补救性CABG。补救性CABG组的手术死亡率在3组中最高（23.81%）（P < 0.001）。与非CABG相比，补救性CABG与手术死亡率增加相关[比值比：18.96，95%置信区间（CI）7.32 - 49.08，P < 0.001]，而计划性CABG则无显著差异。中位随访期为24.80（四分位间距11.73 - 39.10）个月。Kaplan-Meier分析显示补救性CABG组的总生存率较差（对数秩P值 < 0.001）。与非CABG相比，补救性CABG显著增加了全因晚期死亡率（风险比13.69，95% CI 6.53 - 28.70，P < 0.001），而计划性CABG则无此情况。CABG患者中2年移植血管闭塞的累积发生率为24.54%。
在接受TAR和带支架象鼻手术治疗TAAD的患者中，补救性CABG与手术死亡率和全因死亡率增加显著相关。需要进一步研究以明确补救性CABG的原因。
