Protective Coronary Artery Bypass Grafting Improves Surgical Outcomes in Acute Type A Aortic Dissection With Coronary Ostial Involvement

This single-center ambidirectional cohort study analyzed 617 patients with acute type A aortic dissection (ATAAD) who had coronary ostial involvement from 2019–2023. Patients underwent either isolated coronary ostial reconstruction (COR, n=507) or protective coronary artery bypass grafting (CABG, n=110), following COR or suture closure in severe cases (Neri A >50 percent margin, Neri B with distal entry, Neri C). Despite presenting with more severe coronary involvement and higher rates of malperfusion, the CABG group had significantly less procedural myocardial injury (2.7 percent vs 9.3 percent) and a trend toward fewer serious adverse events (2.7 percent vs 8.1 percent). Multivariable regression confirmed that protective CABG reduced serious adverse events (OR 0.24, P=0.028). The median follow-up was 26 months. Long-term survival did not differ between groups, although graft occlusion occurred in approximately 22 percent of CABG patients at two years. The authors conclude that protective CABG enhances perioperative safety in severe ATAAD coronary involvement without compromising long-term survival.