Related Experiment Videos
[Surgery for aortic aneurysms with coronary disease]
K Yamana1, K Kosuga, K Uraguchi
1Second Department of Surgery, Kurume University School of Medicine, Japan.
Insights
For patients undergoing surgery for dissecting aneurysms, coronary artery bypass grafting (CABG) is recommended for those with good coronary run-off and low ejection fraction. Temporary axillofemoral bypass grafting (AFBG) is preferred for patients with poor run-off to prevent cardiac afterload.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Cardiac Surgery
Context:
- Dissecting aneurysms pose significant surgical challenges, often coexisting with coronary artery disease.
- Management strategies must address both the aneurysm and potential cardiac complications.
- Surgical outcomes depend on careful patient selection and tailored revascularization approaches.
Purpose:
- To evaluate the incidence of coronary artery disease in patients undergoing surgery for dissecting aneurysms.
- To assess the effectiveness of different surgical strategies for coronary revascularization in this patient cohort.
Summary:
- A retrospective review of 52 patients with dissecting aneurysms revealed coronary dissections in 7.7% requiring repair.
- Coronary artery disease was present in 8.5% of thoracic aneurysm patients and 5.6% of abdominal aneurysm patients.
- Surgical management varied, including Bentall's procedure, coronary artery bypass grafting (CABG), and temporary axillofemoral bypass grafting (AFBG), depending on coronary anatomy and ejection fraction.
Impact:
- Identifies optimal surgical strategies for patients with aneurysms and concurrent coronary artery disease.
- Highlights the importance of assessing coronary artery disease preoperatively.
- Provides evidence-based recommendations for preventing cardiac complications during aneurysm surgery.
Abstract:
Between 1981 and 1988, 52 patients with dissecting aneurysms were operated and four of them (7.7%) had right coronary dissections that were repaired by Bentall's method with or without right coronary bypass grafting (CABG). Three (8.5%) of 35 patients with thoracic aneurysms had coronary disease. Among them, two had one vessel disease (1VD) and one had 2VD; two underwent temporary axillofemoral bypass grafting (AFBG) without CABG and one underwent extracorporeal circulation with CABG. Eight (5.6%) of 142 patients with abdominal aneurysms had coronary disease. They consisted of three patients with 1VD, two with 2VD and three with 3VD; their ejection fraction rates were 0.46 to 0.75. Three of them underwent temporary AFBG and one first underwent CABG but later underwent abdominal aortic graft replacement. In conclusion, patients with good coronary distal run-off and a low ejection fraction rate (under 0.5) should initially undergo CABG, but for those with poor run-off, temporary AFBG is better to prevent cardiac afterload.