Open Aortic Arch Reconstruction After Coronary Artery Bypass Surgery: Worth the Effort?

Eduard Quintana, Pietro Bajona, Hartzell V Schaff, Joseph A. Dearani, Richard Daly, Kevin Greason, Alberto Pochettino

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Open aortic arch surgery after coronary artery bypass grafting (CABG) is considered a high-risk operation. We reviewed our surgical approach and outcomes to establish the risk profile for this patient population. In methods, from 2000-2014, 650 patients underwent aortic arch surgery with circulatory arrest. Of these, 45 (7%) had previous CABG. Complete medical record was available for review including all preoperative coronary angiograms and detailed management of myocardial protection. In results, the mean interval from previous CABG to aortic arch surgery was 6.8 ± 7.1 years. At reoperation, 33 (73%) patients had hemiarch replacement and 12 (27%) had a total arch replacement. The following were the indications for surgery: fusiform aneurysm in 20 (44%), pseudoaneurysm in 6 (13%), endocarditis in 4 (9%), valvular disease in 5 (11%), and acute aortic dissection in 10 (22%). There were 6 perioperative deaths (13%) and 1 stroke (2.2%). Selective antegrade cerebral perfusion was used in 13 patients (28.9%) and retrograde perfusion in 6 (13.3%). Survival was 74%, 65%, and 52% at 1, 3, and 5-year follow-up, respectively. Only predictors of early mortality were age (odds ratio = 1.20, CI: 1.01-1.44; . P = 0.04) and nonuse of retrograde cardioplegia for myocardial protection (odds ratio = 6.80, CI: 1.06-43.48; . P = 0.04). Intermediate survival of these patients was significantly lower than those of a sex-matched and age-matched population (P <0.001). In conclusion, aortic arch surgery after previous CABG can be performed with acceptable early and midterm results and low risk of stroke. Perfusion strategies and myocardial protection contribute to successful outcomes.

Original languageEnglish (US)
JournalSeminars in Thoracic and Cardiovascular Surgery
DOIs
StateAccepted/In press - 2016

Fingerprint

Thoracic Aorta
Coronary Artery Bypass
Perfusion
Stroke
Odds Ratio
Induced Heart Arrest
Survival
False Aneurysm
Endocarditis
Reoperation
Population
Medical Records
Aneurysm
Dissection
Angiography
Mortality

Keywords

  • Aneurysm
  • Aortic arch
  • Coronary artery surgery
  • Coronary disease
  • Reoperations

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Open Aortic Arch Reconstruction After Coronary Artery Bypass Surgery : Worth the Effort? / Quintana, Eduard; Bajona, Pietro; Schaff, Hartzell V; Dearani, Joseph A.; Daly, Richard; Greason, Kevin; Pochettino, Alberto.

In: Seminars in Thoracic and Cardiovascular Surgery, 2016.

Research output: Contribution to journalArticle

Quintana, Eduard ; Bajona, Pietro ; Schaff, Hartzell V ; Dearani, Joseph A. ; Daly, Richard ; Greason, Kevin ; Pochettino, Alberto. / Open Aortic Arch Reconstruction After Coronary Artery Bypass Surgery : Worth the Effort?. In: Seminars in Thoracic and Cardiovascular Surgery. 2016.
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title = "Open Aortic Arch Reconstruction After Coronary Artery Bypass Surgery: Worth the Effort?",
abstract = "Open aortic arch surgery after coronary artery bypass grafting (CABG) is considered a high-risk operation. We reviewed our surgical approach and outcomes to establish the risk profile for this patient population. In methods, from 2000-2014, 650 patients underwent aortic arch surgery with circulatory arrest. Of these, 45 (7{\%}) had previous CABG. Complete medical record was available for review including all preoperative coronary angiograms and detailed management of myocardial protection. In results, the mean interval from previous CABG to aortic arch surgery was 6.8 ± 7.1 years. At reoperation, 33 (73{\%}) patients had hemiarch replacement and 12 (27{\%}) had a total arch replacement. The following were the indications for surgery: fusiform aneurysm in 20 (44{\%}), pseudoaneurysm in 6 (13{\%}), endocarditis in 4 (9{\%}), valvular disease in 5 (11{\%}), and acute aortic dissection in 10 (22{\%}). There were 6 perioperative deaths (13{\%}) and 1 stroke (2.2{\%}). Selective antegrade cerebral perfusion was used in 13 patients (28.9{\%}) and retrograde perfusion in 6 (13.3{\%}). Survival was 74{\%}, 65{\%}, and 52{\%} at 1, 3, and 5-year follow-up, respectively. Only predictors of early mortality were age (odds ratio = 1.20, CI: 1.01-1.44; . P = 0.04) and nonuse of retrograde cardioplegia for myocardial protection (odds ratio = 6.80, CI: 1.06-43.48; . P = 0.04). Intermediate survival of these patients was significantly lower than those of a sex-matched and age-matched population (P <0.001). In conclusion, aortic arch surgery after previous CABG can be performed with acceptable early and midterm results and low risk of stroke. Perfusion strategies and myocardial protection contribute to successful outcomes.",
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