Related Experiment Videos
Cardiac assessment with thallium scanning prior to aortic aneurysm repair
Insights
Screening for coronary artery disease in aortic aneurysm patients identified significant disease in 33%. Cardiac intervention before aneurysm repair showed zero mortality, suggesting potential long-term survival benefits.
Area of Science:
- Cardiology
- Vascular Surgery
- Diagnostic Imaging
Background:
- Coronary artery disease (CAD) is a common, serious comorbidity in patients with aortic aneurysms.
- The necessity of cardiac screening and intervention before aortic aneurysm repair remains a debated topic.
- Aortic aneurysms pose significant risks, with comorbid CAD contributing to morbidity and mortality.
Purpose of the Study:
- To evaluate the outcomes of cardiac screening and intervention in patients undergoing aortic aneurysm repair.
- To determine the incidence of significant coronary artery disease in this patient population.
- To assess the safety and efficacy of a policy involving cardiac intervention prior to aneurysm repair.
Main Methods:
- Prospective documentation of outcomes in 102 consecutive patients undergoing aortic aneurysm repair.
- Cardiac screening using thallium scanning and/or angiography.
- Analysis of correlation between cardiac history, ECG, and screening results.
- Evaluation of perioperative and short-term outcomes.
Main Results:
- Significant coronary artery disease was detected in 33% of patients.
- Two patients underwent coronary artery bypass or angioplasty before aneurysm repair.
- No cardiac mortality was observed post-aneurysm repair.
- Overall mortality was 2% on an intention-to-treat basis.
- Cardiac intervention followed by repair in 20 patients resulted in zero mortality.
Conclusions:
- Cardiac screening with thallium scanning effectively identifies significant coronary disease in aortic aneurysm patients.
- A strategy of cardiac intervention followed by timely aneurysm repair appears safe, with zero mortality in this series.
- While short-term benefits are difficult to quantify, this approach may improve long-term survival for patients with aortic aneurysms and comorbid CAD.
Abstract:
Coronary artery disease occurs commonly in patients with aortic aneurysms and is a major cause of morbidity and mortality. The role of screening and intervention for cardiac disease prior to aneurysm repair is controversial. The outcome after cardiac screening with thallium scanning and/or angiography in 102 consecutive patients undergoing aortic aneurysm repair was documented. Significant coronary artery disease was found in 34 (33%) patients and two patients had either coronary artery bypass or angioplasty prior to aneurysm repair. There was no cardiac mortality after aneurysm repair and the overall mortality on an intention-to-treat basis was 2%. There was good correlation between prior history of cardiac events, electrocardiography (ECG) and the results of screening with thallium scanning and angiography. There was no correlation between cardiac history, ECG and the incidence of cardiac events in the postoperative period. Significant coronary artery disease was found in 33% of patients without a cardiac history or abnormal ECG. Cardiac screening with thallium scanning confirmed a high incidence of significant coronary disease in patients with aortic aneurysm. In this study, cardiac intervention followed by expedient aneurysm repair in 20 patients was associated with zero mortality. The short-term benefit of such a policy is difficult to prove and its main advantage may be better long-term survival.