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[A simultaneous operation on coronary artery disease and abdominal aortic aneurysm during extracorporeal circulation
S Shiraishi1, K Kawachi, Y Hamada
1Department of Surgery II, Ehime University School of Medicine, Japan.
Insights
Simultaneous coronary artery bypass grafting (CABG) and abdominal aortic aneurysm (AAA) repair using extracorporeal circulation (ECC) is safe for patients with impaired left ventricular function. This approach effectively manages hemodynamic changes during aortic clamping and declamping.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Cardiac Anesthesia
Background:
- Patients with abdominal aortic aneurysm (AAA) often have concomitant coronary artery disease (CAD), necessitating complex surgical management.
- Impaired left ventricular (LV) function, common in patients with CAD, poses significant risks during AAA repair due to hemodynamic instability from aortic clamping.
- Intra-aortic balloon pumping (IABP) is often considered for patients with severely impaired LV function undergoing AAA repair.
Observation:
- Coronary angiography revealed significant stenosis in the left anterior descending, right coronary, and circumflex arteries.
- A 48 mm abdominal aortic aneurysm (AAA) was identified.
- Coronary artery bypass grafting (CABG) was performed first under cardiac arrest, followed by AAA repair using extracorporeal circulation (ECC) while the heart was beating.
Findings:
- The combined CABG and AAA repair using ECC was successfully completed without requiring IABP.
- The patient was weaned from ECC smoothly and discharged 32 days post-operation.
- Cardiopulmonary bypass effectively mitigated hemodynamic stress during aortic clamping and declamping.
Implications:
- Simultaneous CABG and AAA repair with ECC is a safe and effective strategy for patients with compromised left ventricular function.
- This approach can reduce cardiac workload during aortic surgery, minimizing the need for mechanical circulatory support.
- The findings support the integration of cardiopulmonary bypass in managing complex cardiovascular and aortic pathologies concurrently.
Abstract:
A 74-year-old man had an previous antero-septal and inferior myocardial infarction and an abdominal aortic aneurysm (AAA) 48 mm in diameter. Coronary angiography showed obstruction of the left anterior descending artery and of the right coronary artery, and 95% stenosis of the circumflex artery. The value of an ejection fraction of the left ventricle was 33%, measured by left venticulography. CABG and replacement of the aneurysm were performed simultaneously, because of the necessity of an intra-aortic balloon pumping (IABP) due to the impaired left ventricular function. First, CABG was performed under cardiac arrest. After declamping the ascending aorta, subsequently, replacement of AAA was performed while extracorporeal circulation (ECC) assisted heart beating. Weaning from ECC was smooth, and the operation was successful without using IABP. The patient was discharged 32 days after the operation. Consequently, cardiopulmonary bypass during AAA operation could decrease heart loads when hemodynamic states change in aortic clamping or after declamping. A simultaneous operation of CABG and AAA using ECC is safe and effective for impaired left ventricular function.