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Outcome after simultaneous abdominal aortic aneurysm repair and aortocoronary bypass
Rafik A El-Sabrout1, George J Reul, Denton A Cooley
1Department of Cardiovascular Surgery, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston 77225, USA.
Insights
Concomitant myocardial revascularization with abdominal aortic aneurysm (AAA) repair is safe and effective in select patients. This combined approach can decrease perioperative risk and improve long-term survival for patients with coronary artery disease.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
Background:
- Myocardial infarction is a primary cause of mortality following abdominal aortic aneurysm (AAA) repair.
- Staged or concomitant myocardial revascularization strategies yield variable outcomes.
Purpose of the Study:
- To evaluate the safety and efficacy of simultaneous abdominal aortic aneurysm (AAA) resection and aortocoronary bypass (ACB) grafting.
- To identify factors influencing early morbidity and mortality in patients undergoing combined procedures.
Main Methods:
- Retrospective analysis of 42 male patients (mean age 67.2 years) who underwent simultaneous ACB grafting and AAA repair between 1975 and 1998.
- Postoperative management in a cardiothoracic intensive care unit, with a mean stay of 6.1 days and total hospital stay of 17.2 days.
Main Results:
- Early postoperative mortality was 4.8% (2 deaths).
- Higher incidences of wound and bleeding complications were observed compared to AAA repair alone.
- Late follow-up (mean 10 years) showed only 2 cardiovascular-related deaths out of 10 total late deaths.
Conclusions:
- Simultaneous myocardial revascularization and AAA repair is a viable option for select patients.
- The increased risk is associated with the severity of underlying vascular and coronary disease, not the combined procedures themselves.
- Proper perfusion techniques are crucial for preventing cardiac complications during aortic surgery.
Abstract:
Myocardial infarction remains the leading cause of early and late death after abdominal aortic aneurysm (AAA) repair. Myocardial revascularization is staged either before or concomitant with AAA resection, but results are far from uniform. We retrospectively analyzed our experience with patients who underwent concomitant AAA resection and aortocoronary bypass (ACB) to examine the factors affecting early morbidity/mortality and early results. Forty-two patients (all men; mean age, 67.2 years) underwent simultaneous ACB grafting and AAA repair between 1975 and 1998. All were managed postoperatively in the cardiothoracic intensive care unit (mean stay, 6.1 days). The mean total hospital stay was 17.2 days. Two died in the early postoperative period (4.8%): 1 of sustained myocardial failure following a third ACB, and 1 of coagulopathy after concomitant ACB, aortic valve replacement, and AAA. One patient developed a nonfatal MI on postoperative day 3. The incidence of wound and bleeding complications was higher for patients undergoing both ACB and AAA repair than for patients undergoing AAA resection alone. On follow-up (mean, 10 years; range, 7 months to 15 years), only 2 of 10 late deaths were due to cardiovascular causes. We believe that concomitant myocardial revascularization is warranted in select patients requiring elective or urgent AAA resection in order to decrease perioperative risk and improve late survival. Cardiac failure or ischemia during aortic surgery can be prevented by proper perfusion with or without cardiopulmonary bypass. In patients undergoing simultaneous procedures, the increased risk is related to the severity of the vascular and coronary artery disease and not to the combined operations.