Objective: Simultaneous aortic arch repair and coronary artery bypass are associated with considerable morbidity and mortality. We retrospectively analyzed our experience with on-and off-pump coronary artery bypass (CAB) combined with aortic arch repair.
Methods: Before aortic arch repair, distal coronary artery anastomosis was constructed on the arrested heart under CAB (ONCAB: n=14), or on the beating heart before CAB (OPCAB: n=18). We also analyzed data from patients after isolated total arch replacement (TAR: n=20).
Results: Compared with ON CAB, OPCAB was associated with shorter periods of myocardial ischemia (133±24 vs. 180±48 min, P=0.017) and cardiopulmonary bypass (239±35 vs. 306±61 min, P=0.002), less prolonged postoperative ventilation (33% vs. 79%, P=0.027) and lower postoperative peak CK-MB levels (35±19 vs. 99±124 U/L, P=0.012). One (6%) patient after OPCAB and 3 (21%) after ONCAB (P=0.210) died in hospital. Compared with the TAR group, the myocardial ischemic periods after OPCAB (125±30 vs. 133±24min, P=0.401) and postoperative outcomes were similar.
Conclusions : Aortic arch repair with OPCAB offers an option for treating aortic arch aneurysm accompanied by atherosclerotic coronary artery disease.