[One stage operation for ischemic heart disease and abdominal aortic aneurysm with ascending aortic calcification]

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Cardiac Surgery

Background:

• Simultaneous surgical intervention for abdominal aortic aneurysm and ischemic heart disease presents unique challenges.
• Severe ascending aorta calcification complicates standard surgical approaches for coronary artery bypass grafting (CABG).

Observation:

• A 69-year-old male patient presented with a large abdominal aortic aneurysm (7 cm) and severe coronary artery stenosis (LMT 75%, #6 99%).
• Due to severe calcification of the ascending aorta, a double CABG (LITA to LAD, RGEA to PL) was performed under hypothermic ventricular fibrillation.
• The abdominal aortic aneurysm was subsequently repaired during the same cardiopulmonary bypass procedure.

Findings:

• A one-stage surgical approach was successfully employed for combined abdominal aortic aneurysm repair and CABG.
• In situ arterial bypass grafting under hypothermic ventricular fibrillation proved effective in managing severe ascending aorta calcification during CABG.
• The patient experienced a satisfactory postoperative recovery.

Implications:

• This case supports the recommendation of a one-stage operation for patients requiring urgent intervention for both myocardial ischemia and abdominal aortic aneurysm.
• In situ arterial grafting under hypothermic ventricular fibrillation is a viable and useful technique for ischemic heart disease in the context of severe ascending aorta atherosclerosis.
• This combined approach may offer a more efficient treatment strategy for complex cardiovascular conditions.