Unplanned coronary artery bypass grafting during elective aortic root surgery increases perioperative morbidity and mortality

Objective To evaluate risk factors and clinical outcomes of patients who underwent elective aortic root replacement (ARR) and required unplanned intraoperative coronary artery bypass grafting (CABG). Methods This is a multicenter, single-institution, retrospective study of all elective ARRs that occurred from 2014 to 2022. We compared baseline and intraoperative differences, as well as short-term outcomes, between patients who did (ARR-UC) and did not (ARR) require unplanned CABG (UC). Multivariate logistic regression identified predictors of UC and predictors of 30-day mortality. Kaplan-Meier curves were generated with log-rank test to compare long-term survival. Results A total of 884 patients underwent elective ARR, of whom 30 (3.4%) required UC. Female sex was more common in the ARR-UC group (63.3% vs 19.8%, P < .001). Cardiopulmonary bypass time was longer in the ARR-UC group (259 vs 224, P < .001), and the Bentall procedure was more commonly used (93.3 vs 67.6%, P = .002). Thirty-day mortality was greater in the ARR-UC group (13.33% vs 1.64%, P < .001), as was the need for mechanical circulatory support, prolonged ventilation, new dialysis, and length of stay, with less frequent discharge to home. Multivariate analysis identified UC as an independent risk factor of 30-day mortality (odds ratio [OR], 10.4, P = .001). Female sex was strongly associated with the need for UC (OR, 6.46, P < .001); on subgroup analysis, non-dominant RCA was not (OR, 0.71, P = .614). Conclusions The need for UC at the time of elective aortic root surgery significantly increases the incidence of major complications and 30-day mortality. Female sex is an important risk factor for UC, whereas nondominant RCA is not.