Related Experiment Videos
Detection and management of concomitant coronary artery disease in patients undergoing thoracic aortic surgery
1Section of Cardiovascular Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
Insights
Detecting coronary artery disease before thoracic aortic surgery is crucial. Complete revascularization of significant coronary stenosis is essential to reduce postoperative cardiac events in these high-risk patients.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Vascular Surgery
Background:
- Coronary artery disease (CAD) management in patients undergoing thoracic aortic surgery remains challenging.
- Established methods for CAD detection and management in this specific patient population are lacking.
Purpose of the Study:
- To evaluate the impact of coronary angiography and revascularization on perioperative cardiac events in patients undergoing thoracic aortic surgery.
- To identify risk factors for adverse cardiac outcomes in this cohort.
Main Methods:
- A retrospective study of 192 patients undergoing elective thoracic aortic surgery.
- Coronary angiography was performed based on CAD history or positive dipyridamole myocardial perfusion imaging.
- Outcomes were compared between patients who underwent coronary angiography (Group A) and those who did not (Group B).
Main Results:
- The incidence of cardiac events (perioperative myocardial infarction or cardiac death) was significantly higher in Group A (11%) compared to Group B (3%, p < 0.05).
- Incomplete revascularization of major coronary arteries with significant stenosis was identified as a significant risk factor for postoperative cardiac events (p = 0.0106).
- Four patients were inoperable due to complications from coronary angiography or aneurysm rupture post-revascularization.
Conclusions:
- Dipyridamole myocardial perfusion imaging can be a useful screening tool, but additional selection criteria for coronary angiography are necessary.
- Complete revascularization of significant coronary artery stenosis is critical for reducing perioperative cardiac events in patients undergoing thoracic aortic surgery.
Objectives:
No method has been established to detect and manage coronary artery disease in patients undergoing thoracic aortic surgery.
Methods:
Subjects were 192 patients scheduled for elective thoracic aortic surgery. Selection criteria for coronary angiography included a history of coronary artery disease or a positive dipyridamole myocardial perfusion imaging test.
Results:
Four patients were inoperable due to complications associated with coronary angiography or aneurysm rupture following coronary revascularization. A total of 55 patients with coronary angiography (group A) underwent 57 thoracic aortic operations and 133 patients without coronary angiography (group B) underwent 143 similar operations. Of 13 group A patients with significant coronary stenosis, 9 underwent either preoperative percutaneous transluminal coronary angioplasty (n = 3) or concomitant coronary artery bypass (n = 6). Perioperative myocardial infarction occurred in 3 group A patients (5%) and in 4 group B patients (1%, ns). The incidence of cardiac events--perioperative myocardial infarction or cardiac death--in group A (11%, 6/57) was higher than that in group B (3%, 4/143; p < 0.05). Multivariate analysis demonstrated incomplete revascularization of major coronary arteries with significant stenosis as a risk factor for cardiac events (p = 0.0106).
Conclusions:
Although dipyridamole myocardial perfusion imaging was useful, additional selection criteria for coronary angiography is needed. Complete revascularization of major coronary arteries with significant stenosis is essential to reduce postoperative cardiac events.