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Cardiac complications of aneurysm repair
J B Campbell1, J Baker, D M Morris
1Department of Surgery, Louisiana State University Medical Center, Shreveport.
Insights
This study found a low risk of heart attack or death after abdominal aortic aneurysm repair, even for patients with existing coronary artery disease. Prophylactic bypass surgery is likely unnecessary for most patients.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Cardiac Surgery
Background:
- Coronary artery disease (CAD) poses risks during major vascular surgery.
- Abdominal aortic aneurysm (AAA) resection is a significant surgical procedure.
- Assessing perioperative cardiac events is crucial for patient management.
Purpose of the Study:
- To evaluate early morbidity and mortality from CAD in patients undergoing elective infrarenal AAA resection.
- To determine the necessity of prophylactic coronary artery bypass surgery before AAA repair.
Main Methods:
- Retrospective chart review of 49 patients undergoing AAA resection (Sept 1978 - Feb 1986).
- Patients categorized into two groups: with (n=21) and without (n=28) clinical evidence of CAD.
- Cardiac events (myocardial infarction, death) assessed within 30 days post-surgery using cardiac enzyme levels and ECG.
Main Results:
- No cardiac events occurred in patients without clinical CAD (group 2).
- One definite (4.5%) and two possible (9.5%) myocardial infarctions occurred in patients with clinical CAD (group 1).
- All cardiac events were detected via enzyme measurements, as patients were asymptomatic.
Conclusions:
- Elective AAA resection has a low incidence of perioperative cardiac events, even in patients with known CAD.
- Prophylactic coronary artery bypass surgery is not indicated for the majority of patients requiring AAA repair.
- Risk stratification for cardiac events should be considered in AAA repair candidates.
Abstract:
To assess the early morbidity and mortality from coronary artery disease (CAD), we reviewed the charts of 49 patients who had elective resection of infrarenal abdominal aortic aneurysms between September 1978 and February 1986 at the VA and LSU medical centers in Shreveport. On the basis of history, physical examination, and resting electrocardiogram, patients were divided into two groups--those with clinical evidence of coronary artery disease (group 1, n = 21) and those without clinical evidence of coronary artery disease (group 2, n = 28). End points measured were perioperative (30-day) myocardial infarction (MI) rate and death. A definite MI was diagnosed when an abnormally elevated CPK-MB was accompanied by a new electrocardiographic abnormality or a reversal of the normal LDH isoenzyme pattern. A possible MI was diagnosed when an elevated CPK-MB was the only abnormality. In group 1, one definite (4.5%) and two possible (9.5%) MIs occurred. In group 2, there were no definite or possible MIs. All cardiac events were discovered by measurements of cardiac enzymes, since none of the patients had cardiac symptoms. This retrospective study reveals a low incidence of clinically significant cardiac events after resection of abdominal aortic aneurysms, even in patients with clinical evidence of coronary artery disease. Prophylactic coronary artery bypass surgery does not appear to be necessary for most patients needing repair of an abdominal aortic aneurysm.