OBJECTIVES: Evaluate the impact of coronary artery bypass grafting (CABG) on outcomes in patients undergoing aortic root replacement (ARR). METHODS: This was a retrospective cohort study of patients undergoing elective ARR at a single high-volume center. Patients were stratified based on whether they underwent concomitant CABG, and outcomes were compared using multivariable regression and survival analysis. RESULTS: A total of 1518 patients (87.2%) underwent isolated ARR while 223 (12.8%) underwent ARR with CABG. A majority (N = 205, 91.9%) of CABG procedures were elective. In 18 patients (8.1%) CABG was needed emergently. Patients requiring CABG were older (64.8 ± 9.8 vs 55.1 ± 14.5 years, p < 0.001) with a greater incidence of comorbidities. Female sex [OR 4.54 (1.57-12.62), p = 0.004] and smaller aortic root size [OR 0.34 (0.16-0.75), p = 0.007] were associated with need for emergency CABG on multivariable analysis. Operative mortality (OM) was significantly higher in all patients needing concomitant CABG [1.8% vs 0.2%; OR 6.08 (1.16-35.3), p = 0.032]. Among those needing CABG, emergency CABG patients had a higher OM than elective CABG [11.1% vs 1%; OR 12.5 (1.45-100), p = 0.014]. Respiratory complications were more common after emergency CABG as was the incidence of postoperative renal dysfunction and a composite of major adverse events. 10-year survival for all patients requiring CABG was not significantly compromised [73.8% vs 86.2%, HR 0.98, (0.6-1.59), p = 0.937]. CONCLUSIONS: Elective and emergency CABG increase operative risk but do not reduce long-term survival in patients undergoing ARR. Females and those with small aortic roots are at particular risk for needing emergency CABG.