Protective Coronary Artery Bypass Grafting Improves Surgical Outcomes in Acute Type A Aortic Dissection With Coronary Ostial Involvement.

Abstract

Acute type A aortic dissection (ATAAD) with coronary ostial involvement poses significant surgical challenges. We describe two surgical approaches to managing coronary involvement and assess their outcomes. Between January 2019 and December 2023, 617 acute type A aortic dissection patients with coronary involvement were enrolled. Based on our institutional surgical protocol, 507 patients underwent isolated coronary ostial reconstruction, whereas 110 received protective coronary artery bypass grafting (CABG) after coronary ostial reconstruction or closure in cases of severe coronary involvement (defined as Neri A with >50% ostial margin involvement, Neri B with distal entry, or Neri C). Serious adverse events were defined as operative mortality, mechanical support, or stroke. Logistic regression identified factors associated with serious adverse events. Operative mortality occurred in 23 patients (3.73%), and 44 patients (7.13%) experienced serious adverse events. Despite more severe coronary involvement (P < .001) and coronary malperfusion (P < .001) at baseline, the protective CABG group showed significantly lower procedural myocardial injury (2.73% vs 9.27%, P = .037) and a trend toward fewer serious adverse events (2.73% vs 8.09%, P = .076). Logistic regression identified that protective CABG was associated with a reduced risk of serious adverse events (odds ratio, 0.24; 95% CI, 0.07-0.86; P = .028). The median follow-up was 25.95 months. Kaplan-Meier analysis revealed no significant difference in cumulative survival between the 2 groups (log-rank P = .70). Our institutional surgical protocol demonstrates safety and effectiveness. The protective CABG approach was associated with a reduced risk of serious adverse events without impacting overall survival, supporting its more aggressive use in acute type A aortic dissection with severe coronary involvement.