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Results from coronary artery bypass surgery combined abdominal aortic aneurysm repair
K Kawachi1, S Kitamura, S Taniguchi
1Department of Surgery II, Ehime University School of Medicine, Japan.
Insights
Combined coronary artery bypass surgery and abdominal aortic aneurysm repair is safe for selected emergency patients. This combined approach showed no in-hospital deaths and no late cardiac complications in a 29-month follow-up.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Background:
- Coronary artery disease (CAD) significantly increases mortality and morbidity in patients undergoing abdominal aortic aneurysm (AAA) repair.
- Simultaneous emergency operations for both CAD and AAA present complex management challenges.
Purpose of the Study:
- To evaluate the safety and efficacy of combined coronary artery bypass surgery (CABG) and AAA repair in patients requiring urgent intervention for both conditions.
- To assess outcomes, including complications and mortality, of this combined surgical approach.
Main Methods:
- Seventeen patients with concurrent CAD and AAA underwent combined CABG and AAA repair.
- Procedures involved either sequential surgery (CABG first, then AAA repair) or simultaneous repair with cardiopulmonary bypass.
- Internal thoracic arteries were predominantly used for bypass grafting.
Main Results:
- No surgical or in-hospital deaths occurred.
- Three patients experienced postoperative complications: bleeding requiring reoperation, wound infection, and transient neural disorder.
- Mean follow-up of 29 months revealed no late cardiac complications or deaths.
Conclusions:
- Combined CABG and AAA repair is a reasonable option for carefully selected patients with urgent indications for both procedures.
- Performing AAA repair during cardiopulmonary bypass is safe and effective, particularly for patients with severe left ventricular dysfunction.
Objective:
Complication from coronary artery disease is a major cause of mortality and morbidity in patients undergoing abdominal aortic aneurysm repair. We report our results from coronary artery bypass surgery performed in combination with abdominal aortic aneurysm repair in patients with coronary artery disease and abdominal aortic aneurysm, each being an indication for an emergency operation.
Methods:
Seventeen patients underwent combined coronary artery bypass surgery and abdominal aortic aneurysm repair. The mean age of the patients was 67.6 +/- 5.2 years. Four had left main disease, 8 patients had triple-vessel disease, and 12 had a prior myocardial infarction. The average left ventricular ejection fraction was 0.49 +/- 0.13. The average abdominal aortic aneurysm diameter was 6.2 +/- 1.0 cm (range 4.5-8.0 cm). Thirteen patients underwent coronary artery bypass surgery followed by abdominal aortic aneurysm repair after discontinuation of cardiopulmonary bypass. In the remaining four patients, including one patient with severe left ventricular dysfunction, cardiopulmonary bypass was continued as a circulatory assist until the abdominal aortic aneurysm repair was completed. The left internal thoracic artery was used in 14 patients, and the right internal thoracic artery in one patient.
Results:
Postoperative surgical complications occurred in three patients (bleeding in one patient requiring reoperation, abdominal subcutaneous wound infection in another and transient neural disorder in the others). There were no surgical or in-hospital death. There was no late cardiac complication and no late cardiac death after a mean of 29 months follow-up.
Conclusions:
We concluded that combined surgery was reasonable for selected patients with combined coronary artery disease and abdominal aortic aneurysm, each of which is an indication for an urgent operation. The aortic aneurysm repair during cardiopulmonary bypass for patients with severe left ventricular dysfunction was safe and effective.