Aortic arch repair with coronary artery revascularization.

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 ONCAB, 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 +/- 24 min, 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.