Early and midterm outcomes of concomitant coronary artery bypass grafting for coronary artery disease in surgical repair of type A aortic dissection.

BACKGROUND

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.

METHODS

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.

RESULTS

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).

CONCLUSIONS

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.