Differential outcomes of indication-specific coronary artery bypass grafting in acute type A aortic dissection

OBJECTIVES This study aimed to analyze how different indications for coronary artery bypass grafting impact early mortality and long-term outcomes in patients with acute type A aortic dissection at a single high-volume center. METHODS Between 2010 and 2018, patients diagnosed with acute type A aortic dissection who underwent emergency surgical repair at Fuwai Hospital were included. Patients were categorized by presence of concomitant coronary artery bypass grafting. Within this group, patients were further stratified by indication: coronary artery dissection, coronary artery disease, and heart failure after declamping. RESULTS A total of 972 patients (mean age 47 years) were included. The 30-day mortality was significantly higher in the coronary artery bypass grafting group [18/119 (15.1%) vs 48/853 (5.6%), P < 0.001], with rates of 8.1% (5/62) for coronary artery dissection, 5.7% (2/35) for coronary artery disease, and 50% (11/22) for heart failure after declamping. Multivariable logistic regression analysis revealed that bypass grafting for heart failure after declamping increased 30-day mortality (odds ratio 3.90, 95% confidence interval 1.07–14.22). Overall, 10-year survival was 82.0%. Landmark analysis revealed that heart failure after declamping patients had non-inferior late survival compared to other subgroups, whereas patients with coronary artery disease exhibited the lowest late survival rate (P = 0.002). CONCLUSIONS Coronary artery bypass grafting for heart failure after declamping significantly increases the risk of 30-day mortality but not long-term mortality. Bypass grafting for coronary artery disease does not affect 30-day mortality but decreases long-term survival beyond this period compared to patients without bypass grafting.