A single centre experience of simultaneous open abdominal aortic aneurysm and cardiac surgery
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Andrew Kordowicz1, Jonathan Ghosh, Mohamed Baguneid
1Department of Vascular Surgery, University Hospital of South Manchester NHS Foundation Trust, Southmoor Road, Manchester M23 9LT, UK.
Insights
Simultaneous open repair of abdominal aortic aneurysm (AAA) and cardiac surgery is a feasible option for high-risk patients unsuitable for endovascular repair. This combined approach offers improved outcomes for complex cardiovascular and aortic conditions.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Thoracic Surgery
Background:
- Optimal management for patients with symptomatic cardiac disease and abdominal aortic aneurysm (AAA) unsuitable for endovascular repair remains controversial.
- This study addresses the challenge of managing patients requiring simultaneous intervention for both conditions.
Purpose of the Study:
- To evaluate the feasibility and outcomes of synchronous open cardiac and abdominal aortic aneurysm surgery in patients unsuitable for endovascular AAA repair.
Main Methods:
- A prospectively maintained database and case note review were used to analyze 13 patients undergoing synchronous cardiac and open AAA surgery between June 2002 and December 2008.
- All patients underwent open AAA repair (juxtarenal or infrarenal) and cardiac procedures (coronary artery bypass grafting and/or valve replacement) on cardiopulmonary bypass.
Main Results:
- The median age of patients was 78 years. Endovascular AAA repair was not possible due to hostile anatomy.
- Two perioperative deaths occurred (15%). Complications included transient renal impairment, pneumonia, and arrhythmias.
- Eleven patients survived with improved New York Heart Association (NYHA) functional class at six months.
Conclusions:
- Simultaneous open repair of AAA and cardiac surgery is a feasible and effective option for high-risk, anatomically challenging patients.
- Close collaboration between vascular and cardiac surgical teams is crucial for successful management.
Objectives:
Controversy exists over the optimal management of patients with both symptomatic cardiac disease and significant abdominal aortic aneurysm (AAA), but who are unsuitable for endovascular treatment for either pathology. We present our single centre series of synchronous cardiac and aortic aneurysm surgery in patients anatomically unsuitable for endovascular AAA repair.
Methods:
All patients undergoing synchronous cardiac and open AAA surgery between June 2002 and December 2008 were analysed using a prospectively maintained database supplemented with case note review.
Results:
Thirteen patients with a median age of 78 years underwent combined surgery. Two AAA were juxtarenal and the remainder infrarenal with a median diameter of 7 cm (4.8-11), of which three were symptomatic. In all cases, endovascular repair was not possible due to either hostile iliac or neck anatomy. Eleven patients underwent coronary artery bypass grafting (CABG), one CABG plus aortic valve replacement and one patient aortic valve replacement only. All patients were operated on cardiopulmonary bypass (CPB) and received autologous cell salvaged blood. Median CPB and operative time was 182 (141-260) and 420 (360-490) min, respectively. There were two deaths: the first after 90 days from multi-organ failure and stroke, the second following three days from multi-organ failure. Complications comprised: four transient renal impairment; one transient jaundice; four pneumonia; one unstable sternum; and four arrhythmias with one patient requiring a permanent pacemaker. Two patients suffered transient diarrhoea but no other features of intestinal ischaemia. The remaining 11 patients are alive with a median New York Heart Association (NYHA) score improvement from III to II at six months.
Conclusion:
Simultaneous open repair of AAA and cardiac surgery is a feasible option for this high-risk and anatomically challenging patient group. This experience highlights the need for close cooperation between vascular and cardiac teams.
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