Need for Coronary Artery Bypass Grafting in Acute Type A Aortic Dissection: Clinical Insights, Diagnostic Gaps, and Surgical Outcomes

<b>Objectives:</b> The need for concomitant coronary artery bypass grafting during acute type A aortic dissection repair is common and associated with high mortality. This study aims to characterize the patient cohort, assess outcomes, and evaluate the role of preoperative diagnostics in these high-risk patients. <b>Methods:</b> Patients who underwent concomitant coronary artery bypass and acute type A aortic dissection repair between March 2007 and June 2023 were included. In-hospital survivors and non-survivors were compared. Logistic regression analyses were performed to identify predictors of in-hospital mortality. Preoperative computed tomography scans were independently reviewed by a cardiovascular radiologist to assess potential coronary involvement. The agreement between computed tomography and intraoperative reports of coronary dissection was evaluated using Cohen's κappa test. <b>Results:</b> The cohort consisted of ninety-eight patients. In-hospital mortality was 26.5% (n = 26). The right coronary artery was the most frequently grafted (57%, n = 56). Elevated preoperative creatine kinase was the only predictor of in-hospital mortality (<i>p</i> = 0.044). Of the 72 available preoperative CT scans, 76% (n = 55) indicated coronary involvement, whereas intraoperative coronary dissection requiring bypass grafting was documented in only 42% (n = 30)). The agreement between computer tomography and intraoperative dissection reports was poor (κappa 0.043 (95% CI, -0.155 to 0.241), <i>p</i> = 0.66). <b>Conclusion:</b> Simultaneous coronary artery bypass during acute type A aortic dissection repair remains associated with high mortality and morbidity. The right coronary artery is most often affected. Coronary bypass is not always linked to coronary dissection, making intraoperative detection challenging. This underscores the importance of preoperative diagnostics, especially computer tomography.