Ken-Ichi Imasaka 1,2 , Yukihiro Tomita 1 , Shigeki Morita 1 , Akira Shiose 3 Show Affiliations »
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. © Indian Association of Cardiovascular-Thoracic Surgeons 2020.
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. © Indian Association of Cardiovascular-Thoracic Surgeons 2020.
Entities: Chemical
Keywords:
CABG; In-hospital mortality; Morbidity; Proximal first approach; Total arch replacement
Year: 2020
PMID： 33100618 PMCID： PMC7573027 DOI： 10.1007/s12055-020-01013-z
Source DB: PubMed Journal: Indian J Thorac Cardiovasc Surg ISSN： 0970-9134