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Surgical treatment of cardiac involvement in Takayasu arteritis
1Department of Cardiothoracic Surgery, Tokyo Medical and Dental University, Japan.
Insights
Surgical management of cardiac issues in Takayasu arteritis is complex. This study details successful surgical approaches for aortic root and coronary artery lesions, with no operative mortality in 15 patients.
Area of Science:
- Cardiovascular Surgery
- Rheumatology
- Vascular Surgery
Background:
- Cardiac involvement is a significant complication of Takayasu arteritis.
- Surgical intervention for aortic root and coronary artery lesions presents challenges due to the inflammatory nature of the disease.
Purpose of the Study:
- To evaluate surgical outcomes for cardiac involvement in Takayasu arteritis.
- To present surgical techniques for aortic and coronary artery lesions in these patients.
Main Methods:
- Retrospective analysis of 15 patients with cardiac involvement due to Takayasu arteritis.
- Classification into three groups based on clinical presentation and surgical procedures: coronary artery bypass grafting (CABG), aortic valve replacement/modified Bentall's operation, and combined procedures.
- Detailed description of surgical techniques including graft use, prosthesis fabrication, and fixation methods.
Main Results:
- No operative or hospital mortality observed in the 15 patients.
- One late death due to brain abscess and one graft failure requiring reoperation.
- Successful surgical correction of aortic and/or coronary artery lesions.
Conclusions:
- Surgical treatment for cardiac manifestations of Takayasu arteritis can be performed with favorable outcomes.
- Specific surgical techniques are effective for managing complex aortic root and coronary artery disease.
- Steroid therapy is recommended for active inflammatory stages to optimize surgical results.
Abstract:
Cardiac involvement is a serious disorder in Takayasu arteritis. Surgical treatment of aortic root and coronary artery lesions due to Takayasu arteritis has many potential difficulties due to its inflammatory nature. We operated on 15 patients with cardiac involvement stemming from Takayasu arteritis. These patients are classified into 3 groups depending on the clinical diagnosis and surgical procedures employed: coronary artery involvement alone--coronary artery bypass grafting (CABG), three patients (group A), aortic regurgitation with intact coronary artery--Aortic valve replacement or modified Bentall's operation, eight patients (group B), and aortic regurgitation with coronary artery involvement g aortic valve replacement or modified Bentall's operation with CABG, (4 patients) (group C). CABG was performed using saphenous vein graft. For aortic valve replacement or replacement of both the aortic valve and ascending aorta, a prosthetic valve or composite graft with Teflon felt flange was fabricated during surgery and treated with fibrin glue before insertion. A double fixation method with reinforcement by a Teflon felt strip was employed for proximal anastomosis of the flanged prosthesis. A button-shaped coronary ostium was directly anastomosed to the composite graft. There was no operative or hospital mortality. One patient died of brain abscess at 6 months after surgery and another patient with CABG required a second operation due to graft failure. Steroid therapy is recommended in cases diagnosed as being in an active stage until the inflammatory signs disappear.