Short and Midterm Outcomes of Elective Total Aortic Arch Replacement Combined With Coronary Artery Bypass Grafting.

Background: This study was performed to investigate the early and late outcomes of total aortic arch replacement (TAR) with or without coronary artery bypass grafting (CABG). Methods: From October 1999 to December 2010, 200 consecutive patients underwent elective TAR for nondissecting aneurysm through a median sternotomy. Of this number, 131 (65.5%) had isolated TAR (TAR group) and 69 (34.5%) underwent concomitant CABG (TAR/CABG group). Patients in the TAR/CABG group were older and had more advanced chronic kidney disease and higher additive/logistic European System for Cardiac Operative Risk Evaluation and Japan scores than patients in the TAR group. Results: Overall 30-day mortality was 0.5% (1 of 200) and hospital mortality was 3.5% (7 of 200). Hospital mortality was 1.5% (2 of 131) in the TAR group and 7.2% (5 of 69) in the TAR/CABG group (p = 0.036). Multivariate analysis showed that operation time (odds ratio [OR] 1.01, p = 0.013) was a risk factor for hospital mortality, but failed to demonstrate concomitant CABG as a risk factor. Cox proportional hazard analysis showed that age (OR 1.08, p = 0.05), female sex (OR 3.58, p = 0.0004), chronic kidney disease (OR 7.70, p < 0.0001), and operation time (OR 1.01, p = 0.0002) were risk factors for midterm mortality, whereas concomitant CABG was not (OR 0.92, p = 0.87). There was a significant difference in midterm survival and freedom from major cerebrocardiovascular events in the TAR group versus the TAR/CABG group. Conclusions: Concomitant CABG was not a risk factor for hospital morality with TAR. However, patients with concomitant CABG have more preoperative comorbidities, which may adversely affect outcomes, and which may therefore deserve special attention. [ABSTRACT FROM AUTHOR]