Huang Ling-Chen, Sun Yang-Xue, Shao Ze-Hua, Qian Xiang-Yang, Yu Cun-Tao, 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.
J Thorac Dis. 2025 Mar 31;17(3):1469-1480. doi: 10.21037/jtd-24-1587. Epub 2025 Mar 25.
Type A aortic dissection (TAAD) is frequently complicated by concurrent coronary artery disease (CAD). This study aimed to evaluate the impact of concomitant coronary artery bypass grafting (CABG) for CAD on short- and mid-term outcomes following TAAD surgical repair.
A retrospective, post-hoc analysis was conducted from June 2019 to January 2024, involving 1,083 patients. Among them, 270 patients with CAD were stratified into two groups based on whether CABG for CAD was performed: the CABG and non-CABG groups. The inverse probability of treatment weighting (IPTW) was utilized to adjust for imbalanced characteristics. Kaplan-Meier survival analysis was employed to assess all-cause and midterm mortality.
The overall cohort experienced six operative deaths (2.22%). After IPTW adjustment, the CABG group exhibited a significantly lower incidence of serious adverse events (2.5% 8.3%, P=0.048) and operative mortality (0.5% 4.6%, P=0.02) compared to the non-CABG group. The Kaplan-Meier all-cause survival curve initially showed improvement but deteriorated significantly later, revealing no significant difference between the groups (log-rank P=0.58). However, midterm mortality was significantly higher in the CABG group (log-rank P=0.01). Notably, a high incidence of graft occlusion was observed during follow-up period (42.67% at 3 years and 62.22% at 4 years), especially when the proximal graft was anastomosed to the prosthesis (P=0.02).
Concomitant CABG for CAD in TAAD patients lowers operative mortality but worsens midterm outcomes. The increased midterm mortality is mainly due to the high incidence of graft occlusion, which contributes to cardiovascular events and cardiac dysfunction. Due to the negative impact on long-term patency and prognosis, graft anastomosis to the prosthesis is not recommended.
A型主动脉夹层（TAAD）常并发冠状动脉疾病（CAD）。本研究旨在评估同期冠状动脉旁路移植术（CABG）治疗CAD对TAAD手术修复后短期和中期结局的影响。
对2019年6月至2024年1月的1083例患者进行回顾性事后分析。其中，270例CAD患者根据是否进行CAD的CABG分为两组：CABG组和非CABG组。采用治疗权重逆概率（IPTW）来调整不均衡的特征。采用Kaplan-Meier生存分析评估全因死亡率和中期死亡率。
整个队列中有6例手术死亡（2.22%）。经过IPTW调整后，与非CABG组相比，CABG组严重不良事件发生率（2.5%对8.3%，P = 0.048）和手术死亡率（0.5%对4.6%，P = 0.02）显著更低。Kaplan-Meier全因生存曲线最初显示有所改善，但后来显著恶化，两组之间无显著差异（对数秩P = 0.58）。然而，CABG组的中期死亡率显著更高（对数秩P = 0.01）。值得注意的是，随访期间观察到较高的移植物闭塞发生率（3年时为42.67%，4年时为62.22%），尤其是当近端移植物与人工血管吻合时（P = 0.02）。
TAAD患者同期行CAD的CABG可降低手术死亡率，但会恶化中期结局。中期死亡率增加主要归因于移植物闭塞发生率高，这导致心血管事件和心脏功能障碍。由于对长期通畅性和预后有负面影响，不建议将移植物与人工血管吻合。
