Planned Versus Emergency Coronary Artery Bypass Grafting During Elective Aortic Root Replacement: Short- and Long-Term Outcomes

OBJECTIVES: Evaluate the impact of coronary artery bypass grafting (CABG) on outcomes in patients undergoing aortic root replacement (ARR). METHODS: This was a retrospective cohort study of patients undergoing elective ARR at a single high-volume centre. Patients were stratified based on whether they underwent concomitant CABG, and outcomes were compared using multivariable regression and survival analysis. RESULTS: A total of 1518 patients (87.2%) underwent isolated ARR, while 223 (12.8%) underwent ARR with CABG. A majority (N = 205, 91.9%) of CABG procedures were elective. In 18 patients (8.1%), CABG was needed emergently. Patients requiring CABG were older (64.8 ± 9.8 vs 55.1 ± 14.5 years, P < .001) with a greater incidence of comorbidities. Female sex (OR 4.54 [1.57-12.62], P = .004) and smaller aortic root size (OR 0.34 [0.16-0.75], P = .007) were associated with need for emergency CABG on multivariable analysis. Operative mortality (OM) was significantly higher in all patients needing concomitant CABG (1.8% vs 0.2%; OR 6.08 [1.16-35.3], P = .032). Among those needing CABG, emergency CABG patients had a higher OM than elective CABG (11.1% vs 1%; OR 12.5 [1.45-100], P = .014). Respiratory complications were more common after emergency CABG as was the incidence of postoperative renal dysfunction and a composite of major adverse events. 10-year survival for all patients requiring CABG was not significantly compromised (73.8% vs 86.2%; HR 0.98 (0.6-1.59), P = .937). CONCLUSIONS: Elective and emergency CABG increase operative risk but do not reduce long-term survival in patients undergoing ARR. Females and those with small aortic roots are at particular risk for needing emergency CABG.