Outcomes of total aortic arch replacement with coronary artery bypass grafting.

There are few reports regarding outcomes of total aortic arch replacement (TAAR) with concomitant coronary artery bypass grafting (CABG). This study aimed to analyze outcomes after total arch replacement with CABG in our institute. Between July 2006 and December 2010, 126 patients underwent elective total arch replacement with or without CABG. Of these patients, 56 had concomitant CABG. The mean age was 73.9±5.6 years. Fifteen patients were female. Six patients had chronic aortic dissection, and two patients had previous aortic operations. Total arch replacement was performed with selective cerebral perfusion and the elephant trunk procedure. The mean number of coronary anastomoses was 1.9±1.0. An internal thoracic artery (ITA) and saphenous vein graft were used in 37 (66.1%) and 47 (83.9%) patients, respectively. Only the anastomosis between the in-situ ITA and the left anterior descending artery (LADA) was performed after declamping the aorta using the on-pump beating technique. Operative mortality was 3.6%. Stroke occurred in 7.1% of patients. Early graft patency of bypass grafts was 100%. Composite outcomes of mortality and the rate of major complications of patients with CABG was 19.6%. TAAR with CABG can be safely performed with favorable outcomes.