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[Indication for coronary revascularization in aortic surgery]
Insights
Patients with angina undergoing aortic surgery face high risks of coronary artery disease complications. Preoperative coronary revascularization is recommended for those with angina needing cardiac arrest during aneurysmectomy.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Vascular Surgery
Context:
- Aortic aneurysm surgery presents a complex challenge regarding concurrent coronary artery disease.
- Routine coronary angiography (CAG) is employed to assess coronary artery disease (CAD) in patients scheduled for aortic surgery.
Purpose:
- To determine optimal management strategies for coronary artery disease in patients undergoing elective aortic aneurysm surgery.
- To evaluate the incidence of perioperative complications related to CAD in patients with and without angina.
Summary:
- In thoracic aortic aneurysm (TAA) surgery, 18 of 73 patients had significant CAD, with 3 experiencing angina. Two patients requiring coronary revascularization (CR) underwent concomitant CABG.
- In abdominal aortic aneurysm (AAA) surgery, 38 of 76 patients had CAD, with 7 indicated for CR due to angina.
- Complications occurred in patients with angina who did not receive CR, while those without angina or with CR experienced no complications.
Impact:
- Patients with angina undergoing aortic surgery are at high risk for CAD-related complications.
- Coronary revascularization prior to aneurysmectomy is advised for patients with angina requiring cardiac arrest.
- Patients without angina exhibit a low risk of perioperative myocardial ischemia during aortic surgery.
Unlabelled:
In order to know how to treat the coronary artery disease in scheduled aortic surgery for aortic aneurysms, a prospective study started about ten years ago using routine coronary angiography (CAG). Thoracic aortic aneurysm (TAA): CAG was performed in 73 among 143 patients and 18 had significant coronary artery stenoses (CAD), 3 of whom had angina. Concomitant CABG was performed in 2 of 4 patients requiring coronary revascularization (CR) to prevent intraoperative myocardial ischemia. Complications due to CAD were experienced in the 2 patients without CR despite of angina, while patients without angina or with CR had no complication. Abdominal aortic aneurysm (AAA): Seventy six among 150 patients had CAG, and CAD was found in 38. CR was indicated to 5 of 7 patients with angina. Complications occurred in 2 patients who had not CR in spite of angina. Patients without angina had no complication.
Conclusion:
1) Patients who had angina are at high risk for complications due to CAD. 2) Patients with angina and necessity of cardiac arrest during aneurysmectomy should have coronary revascularization prior to aneurysmectomy. 3) Patients without angina are at low risk for myocardial ischemia in the perioperative period of aortic surgery.