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Coronary artery disease in aortic surgery
P M Orecchia1, P W Berger, C J White
1Peripheral Vascular Surgery Service, Letterman Army Medical Center, Presidio of San Francisco, California.
Insights
Aggressive preoperative cardiac catheterization and bypass grafting significantly reduce cardiac complications in patients undergoing aortic surgery. This approach lowers operative mortality, demonstrating its value in managing coronary artery disease alongside aortic procedures.
Area of Science:
- Cardiology
- Cardiac Surgery
Background:
- Coronary artery disease (CAD) is prevalent in patients requiring aortic surgery.
- The optimal management of concurrent CAD and aortic disease remains a critical clinical question.
Purpose of the Study:
- To prospectively analyze the incidence of CAD in patients undergoing aortic surgery.
- To evaluate the impact of aggressive preoperative cardiac catheterization and myocardial revascularization on outcomes.
Main Methods:
- Prospective analysis of 59 patients undergoing aortic surgery.
- Assessment of coronary artery disease prevalence through cardiac catheterization.
- Evaluation of myocardial revascularization (coronary artery bypass grafting) prior to aortic surgery.
- Analysis of operative mortality and overall mortality associated with the approach.
Main Results:
- 75% of patients had at least one-vessel CAD; 32% had three-vessel or left main disease.
- Preoperative cardiac catheterization and revascularization were performed in 29% of patients.
- Operative mortality was 3.7%, with an overall mortality of 7.4% for the aggressive approach.
- Resting and exercise multiple-gated acquisition scans did not reliably predict CAD in asymptomatic patients.
Conclusions:
- Aggressive preoperative cardiac catheterization and coronary artery bypass grafting reduce the risk of cardiac complications in patients undergoing aortic surgery.
- This strategy appears to improve outcomes despite potential risks associated with staged procedures.
Abstract:
The incidence of coronary artery disease in patients coming to aortic surgery and the impact of aggressive preoperative cardiac catheterization and myocardial revascularization was prospectively analyzed in 59 patients. Seventy-five percent of patients had at least one-vessel involvement, and 32% had three-vessel or left main involvement. Patients with electrocardiographic evidence of coronary artery disease had at least one-vessel involvement 84% of the time and three-vessel, left main involvement 36% of the time. Sixty-four percent of patients with no preoperative indications of coronary artery disease had at least one-vessel involvement and 29% had three-vessel, left main involvement. Resting (39 patients) and exercise multiple-gated acquisition scans (22 patients) did not predict the presence of coronary artery disease in patients without a history or electrocardiographic evidence of coronary artery disease. Myocardial revascularization was performed prior to aortic surgery in 17 patients (29%). The operative mortality was 3.7% with two patients dying from noncardiac-related complications. There were two additional deaths prior to aortic surgery with one patient dying during coronary artery bypass grafting, and one dying of aneurysm rupture prior to repair, making the overall mortality associated with this approach 7.4%. Preoperative cardiac catheterization and an aggressive approach toward coronary artery bypass grafting reduces the risk of cardiac complications in aortic surgery.