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[Surgical treatment of aortic arch aneurysm associated with coronary artery disease]
T Kawashima1, T Kazui, N Inoue
1Department of Surgery, Sapporo Medical College and Hospital, Japan.
Insights
Simultaneous coronary artery bypass grafting (CABG) during aortic arch aneurysm repair improves outcomes. This combined approach enhances myocardial protection, postoperative hemodynamics, and long-term survival for patients with coronary artery disease.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Context:
- Aortic arch aneurysms pose significant surgical challenges, often coexisting with coronary artery disease.
- Surgical repair requires complex techniques, including aortic arch reconstruction and myocardial protection.
Purpose:
- To evaluate the efficacy and outcomes of simultaneous coronary artery bypass grafting (CABG) during aortic arch aneurysm repair.
- To assess the impact of this combined approach on myocardial protection, postoperative hemodynamics, and long-term survival.
Summary:
- Seven patients underwent aortic arch aneurysm repair with concomitant coronary artery bypass grafting (CABG) between 1987 and 1992.
- Atherosclerosis and aortic dissection were the primary etiologies.
- The study highlights the importance of selective cerebral perfusion and myocardial protection strategies.
- Early and late mortality rates were 14% and 14%, respectively, with respiratory failure being a common complication.
Impact:
- Simultaneous CABG is crucial for achieving adequate myocardial protection and favorable postoperative hemodynamics.
- This combined surgical strategy improves long-term survival rates in patients with aortic arch aneurysms and coronary artery disease.
- The findings underscore the benefits of integrated surgical planning for complex cardiovascular conditions.
Abstract:
Graft replacement of the aortic arch aneurysms and concomitant coronary artery bypass grafting (CABG) were performed in the consecutive seven patients for the past five years between 1987 and January 1992, including three (43%) emergency operations. The etiology of aneurysms was atherosclerosis in 4, and aortic dissection in 3. There were one early death (14%) due to MRSA pneumonia, and one late death due to rupture of the abdominal aortic aneurysm 8 months postoperatively. Respiratory failure was frequently complicated immediately after the surgery. Vein grafts were anastomosed to coronary artery during the initial core cooling, and sequential cardioplegia was given through the bypass grafts. Selective cerebral perfusion was carried-out during the reconstruction of the transverse aortic arch and arch vessels in all cases. To achieve sufficient myocardial protection, and to get good postoperative hemodynamics and long-term survivors, it was important to perform the simultaneous CABG at the time of the repair for the aortic arch aneurysm in cases complicated with coronary artery disease.