• Takuya Ogami, Derek Serna-Gallegos, Sarah Yousef, James A Brown, Floyd W Thoma, Kathirvel Subramaniam, Theresa A Gelzinis, Johannes O Bonatti, David J Kaczorowski, Pyongsoo D Yoon, Danny Chu, and Ibrahim Sultan.
• Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA.
• J. Cardiothorac. Vasc. Anesth. 2024 Apr 1; 38 (4): 918923918-923.

ObjectivesUnexpected coronary artery bypass grafting (CABG) is occasionally required during aortic root replacement (ARR). However, the impact of unplanned CABG remains unknown.DesignA single-center, retrospective observational study.SettingAt university-affiliated tertiary hospital.ParticipantsAll patients who underwent ARR from 2011 through 2022.InterventionsAortic root replacement with or without unplanned CABG.Measurements And Main ResultsA total of 795 patients underwent ARR. Among them, 131 (16.5%) underwent planned concomitant CABG, and 34 (4.3%) required unplanned CABG. The most common indication of unplanned CABG was ventricular dysfunction (33.3%), followed by disease pathology (25.6%), anatomy (15.4%), and surgical complications (10.3%). A vein graft to the right coronary artery was the most commonly performed bypass. Infective endocarditis and aortic dissection were observed in 27.8% and 12.8%, respectively. Prior cardiac surgery was seen in 40.3%. The median follow-up period was 4.3 years. Unplanned CABG was not associated with operative mortality (odds ratio [OR] 1.54, 95% CI 0.33-7.16, p = 0.58) or long-term mortality (hazard ratio 0.91, 95% CI 0.44-1.89, p = 0.81). Body surface area smaller than 1.7 was independently associated with an increased risk of unplanned CABG (OR 4.51, 95% CI 1.85-11.0, p < 0.001).ConclusionsUnplanned CABG occurred in 4.3% of patients during ARR, but was not associated with operative mortality or long-term mortality. A small body surface area was a factor associated with unplanned CABG.Copyright © 2024 Elsevier Inc. All rights reserved.

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