Safety of Concomitant Ascending Aortic Aneurysm Repair During Coronary Artery Bypass Grafting: A Society of Thoracic Surgeons Database Study.

Abstract

The 2022 American College of Cardiology/American Heart Association aortic disease guideline recommends concomitant ascending aortic replacement at the same size criteria for all cardiac operations. We sought to determine the added risk of performing an elective prophylactic ascending aortic replacement during coronary artery bypass grafting (CABG) using The Society of Thoracic Surgeons (STS) database. The STS database was queried for all elective adult CABG patients from 2014 to 2023 with either triple-vessel or left main disease >50%. A subgroup undergoing concomitant elective planned ascending aortic replacement was identified. Inverse probability of treatment weighting balanced confounders between the CABG and CABG/aortic groups before outcomes were compared. There were 372,953 CABG patients and 833 (0.2%) concomitant elective ascending aortic replacement patients identified. After inverse probability of treatment weighting, the combined aortic + CABG group had higher rates of almost all STS-reported outcomes including mortality (2.3% vs 1.5%; P = .0473), stroke (3.6% vs 1.1%; P < .0001), prolonged ventilation (9.9% vs 4.4%; P < .0001), renal failure (2.3% vs 1.4%; P = .0170), and combined morbidity and mortality (16.1% vs 8.3%; P < .0001). The relative risk of death for adding ascending aortic replacement to CABG was 1.57 (95% CI, 1.01-2.4); stroke, 3.2 (95% CI, 2.24-4.57); prolonged ventilation, 2.25 (95% CI, 1.83-2.76); renal failure, 1.70 (95% CI, 1.10-2.64); and combined morbidity/mortality, 1.94 (95% CI, 1.65-2.26). Elective ascending aortic replacement is not common in CABG but is associated with significantly higher risk of poor outcomes in the early postoperative period. These findings may help inform guidelines regarding the relative risk of concomitant ascending aortic replacement in elective CABG patients.