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The safety of combined cardiac and vascular operations: how much is too much?
J J Gangemi1, I L Kron, S D Ross
1Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia Health Sciences Center, Charlottesville, VA 22908, USA. jjg5d@virginia.edu
Insights
Combined cardiac and vascular procedures are safe, but multiple vascular reconstructions increase operative risk. A decreased ejection fraction also correlates with poor outcomes in these complex cardiac surgeries.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Surgical Outcomes
Background:
- Combined cardiac and vascular procedures are complex operations.
- Identifying factors predicting poor outcomes is crucial for patient management.
Purpose of the Study:
- To identify predictors of adverse events in patients undergoing combined cardiac and vascular operations.
- To assess the safety and risk factors associated with these combined procedures.
Main Methods:
- Retrospective review of 45 consecutive patients undergoing combined cardiac and vascular operations.
- Classification of patients into two groups: Group I (no morbidity/mortality) and Group II (significant morbidity/mortality).
- Analysis of procedure types (e.g., cardiac/carotid endarterectomy, cardiac/abdominal aortic aneurysm repair) and patient characteristics.
Main Results:
- Overall mortality was 4.4%, with deaths occurring in patients who had cardiac surgery combined with two additional vascular procedures.
- Patients with poor outcomes (Group II) had significantly lower ejection fractions and a higher number of procedures.
- No deaths were observed in patients undergoing cardiac/carotid endarterectomy or cardiac/abdominal aortic aneurysm repair, with only one stroke reported.
Conclusions:
- Combined cardiac surgery and vascular reconstruction can be performed safely.
- Multiple concurrent vascular reconstructions and a reduced ejection fraction are associated with increased operative risk.
- Careful patient selection and risk stratification are essential for optimizing outcomes in these complex surgical cases.
Objective:
The purpose of this study was to identify factors correlating with a poor outcome following combined cardiac and vascular procedures.
Methods:
We reviewed 45 consecutive patients undergoing combined cardiac and vascular operations. These included cardiac/CEA (n=27), cardiac/AAA (n=13), cardiac/AAA/one other vascular reconstruction (n=4), and cardiac/renal artery bypass (n=1). Group I included all patients with no morbidity or mortality (n=41) and Group II included patients who died or suffered significant morbidity (stroke, renal failure) (n=4).
Results:
Overall mortality was 4.4% (2/45). These two patients underwent cardiac surgery combined with two additional vascular procedures (cardiac/AAA/other). In patients undergoing cardiac/CEA or cardiac/AAA, there were no deaths and one stroke (contralateral to CEA). Group II had significantly decreased ejection fraction (39%+/-6% vs 52%+/-1%) and an increased number of procedures (2.75 vs 2.04).
Conclusions:
Combined cardiac surgery and vascular reconstruction can be performed safely. However, multiple vascular reconstructions or the presence of decreased ejection fraction increased operative risk.
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