Wu Bo Chang Brian, Carroll Adam M, Chanes Nicolas, Rosenberg Drake S, Kirsch Michael J, Aftab Muhammad, Reece T Brett
Department of Surgery, University of Colorado School of Medicine, 80045, Aurora, CO, USA.
Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado Denver| Anschutz Medical Campus, 12631 E. 17th Avenue, C-310, 80045, Aurora, CO, USA.
J Cardiothorac Surg. 2025 Apr 21;20(1):215. doi: 10.1186/s13019-025-03431-9.
Hemiarch replacement of the ascending aorta has become routine in many aortic centers. While the addition of coronary bypass does not add a lot of time to the procedure, it carries with more significant comorbidities. We hypothesize that the addition of CABG carries a higher risk of complication than hemiarch alone.
This is a single-center, retrospective cohort study of 419 patients undergoing elective hemiarch surgery between February 2010 and May 2023. Patients were categorized into concomitant CABG (n = 42) and non-CABG (n = 379) groups. Perioperative variables and outcomes were analyzed. Both univariate and multivariate logistic regressions were used to identify predictors for MACE.
Of 419 patients, 42 (10%) patients received adjunctive CABG. This group was older (68.1 vs. 60.4 years, p < 0.001) with more comorbidities associated with coronary artery disease (CAD), such as hypertension (92.9% vs. 59.2%, p < 0.001), type 2 diabetes (33.3% vs. 8.8%, p < 0.001), and atrial fibrillation (19% vs. 5.8%, p = 0.006). CABG patients had longer cardiopulmonary bypass (158 vs. 131 min, p < 0.001) and aortic cross-clamp (115.5 vs. 95 min, p < 0.001) times and required more intraoperative blood products, FFP (4 vs. 2 units, p = 0.010) and platelets (2 vs. 1 units, p < 0.001). Postoperative complications, including arrhythmia (40.5% vs. 21.8%, p = 0.012), mechanical circulatory support (11.9%, 1.9%, p = 0.004), acute kidney injury (16.7% vs. 0.5%, p < 0.001), infection (11.9% vs. 3.7%, p = 0.032), mortality (9.5% vs. 0.5%, p = 0.001), stroke (9.5% vs. 2.1%, p = 0.024), and the composite outcome- MACE (21.4% vs. 2.9%, p < 0.001) were higher in the CABG group. Multivariate analysis identified the number of bypassed vessels (OR: 2.23, CI 1.33-3.69, p = 0.002), age (OR: 1.07, CI: 1.02-1.13, p = 0.006), and female gender (OR: 3.53, CI: 1.31-9.64, p = 0.012) as significant risk factors for MACE.
Concomitant CABG may increase the risk of MACE compared to other patients undergoing hemiarch. These data argue that the risk may be higher for concomitant CABG but should still undergo revascularization. Future research should focus on preoperative optimization, operative strategies, and sex-specific risk factors to improve elective hemiarch replacement outcomes.
升主动脉半弓置换术在许多主动脉疾病治疗中心已成为常规手术。虽然增加冠状动脉搭桥术不会使手术时间延长很多，但会带来更严重的合并症。我们推测，与单纯升主动脉半弓置换术相比，增加冠状动脉搭桥术会带来更高的并发症风险。
这是一项单中心回顾性队列研究，研究对象为2010年2月至2023年5月期间接受择期升主动脉半弓手术的419例患者。患者被分为同期冠状动脉搭桥术组（n = 42）和非冠状动脉搭桥术组（n = 379）。分析围手术期变量和结果。采用单因素和多因素逻辑回归分析来确定主要不良心血管事件（MACE）的预测因素。
419例患者中，42例（10%）接受了同期冠状动脉搭桥术。该组患者年龄更大（68.1岁对60.4岁，p < 0.001），合并更多与冠状动脉疾病（CAD）相关的合并症，如高血压（92.9%对59.2%，p < 0.001）、2型糖尿病（33.3%对8.8%，p < 0.001）和心房颤动（19%对5.8%，p = 0.006）。冠状动脉搭桥术患者的体外循环时间（158分钟对131分钟，p < 0.001）和主动脉阻断时间（115.5分钟对95分钟，p < 0.001）更长，术中需要更多血液制品，新鲜冰冻血浆（4单位对2单位，p = 0.010）和血小板（2单位对1单位，p < 0.001）。冠状动脉搭桥术组术后并发症包括心律失常（40.5%对21.8%，p = 0.012）、机械循环支持（11.9%对1.9%，p = 0.004）、急性肾损伤（16.7%对0.5%，p < 0.001）、感染（11.9%对3.7%，p = 0.032）、死亡率（9.5%对0.5%，p = 0.001）、中风（9.5%对2.1%，p = 0.024）以及复合结局——主要不良心血管事件（21.4%对2.9%，p < 0.001）均更高。多因素分析确定搭桥血管数量（比值比：2.23，95%置信区间1.33 - 3.69，p = 0.002）、年龄（比值比：1.07，95%置信区间：1.02 - 1.13，p = 0.006）和女性性别（比值比：3.53，95%置信区间：1.31 - 9.64，p = 0.012）为主要不良心血管事件的显著危险因素。
与其他接受升主动脉半弓置换术的患者相比，同期冠状动脉搭桥术可能增加主要不良心血管事件的风险。这些数据表明，同期冠状动脉搭桥术的风险可能更高，但仍应进行血运重建。未来的研究应侧重于术前优化、手术策略以及性别特异性危险因素，以改善择期升主动脉半弓置换术的预后。
