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Surgical outcome of elective total arch replacement with coronary artery bypass grafting

Indian Journal of Thoracic and Cardiovascular Surgery volume 36, pages 572–579 (2020)Cite this article

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.

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Funding

This study was not funded by any agency or institution.

Author information

Affiliations

  1. Department of Cardiovascular Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan

    Ken-ichi Imasaka, Yukihiro Tomita & Shigeki Morita

  2. Department of Cardiovascular Surgery, Shimonoseki City Hospital, 1-13-1 Koyocho, Shimonoseki, 750-8520, Japan

    Ken-ichi Imasaka

  3. Department of Cardiovascular Surgery, Faculty of Medicine, Kyushu University Graduate School of Medicine, Fukuoka, Japan

    Akira Shiose

Authors
  1. Ken-ichi Imasaka
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  2. Yukihiro Tomita
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  3. Shigeki Morita
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  4. Akira Shiose
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Contributions

Concept/design: KI, YT

Data analysis/interpretation: KI

Drafting article: KI

Critical revision of article: YT, SM, AS

Approve of article: KI, YT, SM, AS

Statistics: KI

Data collection: KI

Corresponding author

Correspondence to Ken-ichi Imasaka.

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Conflict of interest

The authors declare that they have no conflict interest.

Ethics approval

This study complies with the principles of the Declaration of Helsinki and was approved by the institutional ethics committee.

Consent to participate

Informed consent was obtained from all patients included in this study.

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Imasaka, Ki., Tomita, Y., Morita, S. et al. Surgical outcome of elective total arch replacement with coronary artery bypass grafting. Indian J Thorac Cardiovasc Surg 36, 572–579 (2020). https://doi.org/10.1007/s12055-020-01013-z

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  • DOI: https://doi.org/10.1007/s12055-020-01013-z

Keywords

  • Total arch replacement
  • CABG
  • Proximal first approach
  • In-hospital mortality
  • Morbidity