Surgical outcome of elective total arch replacement with coronary artery bypass grafting
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ORIGINAL ARTICLE
Surgical outcome of elective total arch replacement with coronary artery bypass grafting Ken-ichi Imasaka 1,2
&
Yukihiro Tomita 1 & Shigeki Morita 1 & Akira Shiose 3
Received: 21 April 2020 / Revised: 2 July 2020 / Accepted: 7 July 2020 # Indian Association of Cardiovascular-Thoracic Surgeons 2020
Abstract Purpose We aimed to compare the surgical outcome between total arch replacement with coronary bypass surgery and that without. Methods Between 2008 and 2016, 157 consecutive patients underwent total arch replacement with antegrade cerebral perfusion and moderate hypothermic circulatory arrest using the proximal first approach. They were divided into two groups: total arch replacement with coronary bypass surgery (group 1, n = 38) and that without (group 2, n = 119). Results Of the 38 patients in group 1, 37 (97%) were asymptomatic. The left internal thoracic artery and saphenous vein were used in one (2.6%) and 38 (100%) patients, respectively. The mean number of coronary anastomoses was 1.5 ± 1.0. In-hospital mortality rate was 3.8%. Cardiopulmonary bypass time and operation time in group 1 were significantly longer than those in group 2 (336 ± 52 min vs. 276 ± 38 min, P < 0.0001 and 702 ± 122 min vs. 619 ± 94 min, P < 0.0001, respectively). No differences in in-hospital mortality and perioperative myocardial infarction were found between the groups (5.3% vs. 3.4%, P = 0.633 and 0% vs. 1.7%, P = 1.000, respectively). In the multivariate analysis, age (odds ratio, 1.208; 95% confidence interval, 1.041– 1.497; P = 0.008) and cardiopulmonary bypass time (odds ratio, 1.019; 95% confidence interval, 1.001–1.041; P = 0.041) were significant determinants of in-hospital mortality. Conclusions Although prolonged cardiopulmonary bypass time was a significant determinant of in-hospital mortality, total arch replacement with coronary bypass surgery could be safely performed with favorable outcomes. Keywords Total arch replacement . CABG . Proximal first approach . In-hospital mortality . Morbidity
Introduction Currently, the overall hospital mortality after total arch replacement (TAR) has been declining even among elderly patients because of the improvement in surgical techniques, postoperative intensive care, and sealing grafts used in aortic
* Ken-ichi Imasaka [email protected] 1
Department of Cardiovascular Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
2
Department of Cardiovascular Surgery, Shimonoseki City Hospital, 1-13-1 Koyocho, Shimonoseki 750-8520, Japan
3
Department of Cardiovascular Surgery, Faculty of Medicine, Kyushu University Graduate School of Medicine, Fukuoka, Japan
arch surgery [1]. However, some subgroups may be at an increased surgical risk because of preoperative comorbidity, particularly patients with significant coronary artery disease (CAD). Generally, the concomitant coronary artery bypass grafting (CABG) in the TAR has been considered a risk factor for adverse outcome because of prolonged myocardial isc
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