Coronary artery aneurysms: Evolving trends in surgical management

To evaluate temporal trends and evolution of surgical techniques for coronary artery aneurysms.

From January 2006 to January 2025, 146 patients (age 63 ± 13 years; 37 [25%] female) with 172 coronary aneurysms underwent coronary surgery at Cleveland Clinic. Indications, operative trends, and outcomes were analyzed. Patients were divided into 2 groups: the addressed (N = 85), when the aneurysm was a direct or indirect indication for surgery, and the unaddressed (N = 61), when it was not.

Operative indications in the addressed group were size (58 [68%]), aneurysm-related coronary ischemia (55 [65%]), shunting (27 [32%]), concomitant coronary artery disease (22 [26%]), and infection (4 [4.7%]). In the unaddressed group, coronary ischemia due to coronary artery disease was the sole indication. Patients in the addressed group underwent 1 or more of the following: coronary artery bypass grafting (60 [71%]), (14 [16%] coronary artery bypass grafting alone), excision/ligation (34 [40%]), fistula ligation (31 [36%]), in situ graft-based reconstruction (19 [22%]), and direct repair (9 [11%]). More comprehensive aneurysm-directed repairs, including graft-based reconstruction, increased over time. All unaddressed patients underwent coronary artery bypass grafting alone. Operative mortality was 2.4% and 3.4% for the addressed and unaddressed groups, respectively. Five- and 10-year survivals were 80% and 63% in the addressed group and 63% and 48% in the unaddressed group, respectively. Survival in both groups was similar to our institutional age- and sex-matched coronary artery bypass grafting cohorts (addressed log-rank P = .67; unaddressed log-rank P = .45).

Surgical management of coronary artery aneurysms has evolved toward more complex aneurysm-directed reconstructions. When indicated by aneurysm size, ischemia, shunting, infection, or symptoms, surgical repair can be performed without added risk, with long-term survival comparable to that of the general population undergoing coronary artery bypass grafting.