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[Combined surgery for coronary artery disease and thoracic aortic disease]
H Ohashi1, T Kawai, Y Tsutsumi
1Department of Surgery, Fukui Cardiovascular Center, Japan.
Insights
This study analyzed combined surgery for coronary artery disease and thoracic aortic disease. Complex cases highlight challenges in managing aortic dissection and coronary grafting, impacting patient outcomes.
Area of Science:
- Cardiovascular Surgery
- Thoracic Aortic Disease
- Coronary Artery Disease
Context:
- Simultaneous surgical management of coronary artery disease and thoracic aortic disease presents unique challenges.
- Analysis of six complex cases involving ascending and transverse aortic replacements alongside coronary artery bypass grafting (CABG).
- Specific case presentations include iatrogenic aortic dissection, chronic dissections, aneurysms, and aortitis syndrome.
Purpose:
- To analyze outcomes and challenges of combined surgical procedures for patients with concurrent coronary and thoracic aortic diseases.
- To evaluate the efficacy of different cerebral perfusion strategies (deep hypothermic circulatory arrest, retrograde, and selective cerebral perfusion) during aortic repair.
- To discuss complications such as low cardiac output syndrome and graft issues.
Summary:
- Six patients underwent combined CABG and thoracic aortic surgery, with varied aortic pathologies and surgical approaches.
- Ascending aortic replacement was performed using deep hypothermic circulatory arrest or retrograde cerebral perfusion.
- Transverse aortic replacement utilized selective cerebral perfusion; complications included low cardiac output syndrome and graft anastomotic problems.
Impact:
- Highlights the complexity and risks associated with combined cardiovascular and aortic surgeries.
- Provides insights into managing challenging aortic dissections and coronary artery disease concurrently.
- Underscores the importance of meticulous surgical technique and patient selection for favorable outcomes.
Abstract:
Combined surgery in 6 cases who had coronary artery disease and thoracic aortic disease simultaneously was analyzed. Case # 1 had ascending aortic replacement under deep hypothermic circulatory arrest because of iatrogenic aortic dissection caused by aortic clamp during the routine coronary artery bypass grafting (CABG). Case # 2 had DeBakey type II chronic dissection. Case # 3 had type I aortic dissection 4 years after the initial CABG. Both case # 2 and # 3 had ascending aortic replacement under retrograde cerebral perfusion along with CABG. Transverse aortic replacement was performed in case # 4, # 5 and # 6 under selective cerebral perfusion along with CABG. Case # 4 was associated with ascending-transverse aortic aneurysm. Case # 5 had aortitis syndrome complicated with severe coronary ostial stenosis and cervical branch stenosis. Case # 6 also had aortitis syndrome, severe coronary ostial stenosis, heavily calcified ascending-transverse aorta, and mitral and aortic regurgitation. This case had mitral and aortic valve replacement additionally. Case # 2 died of low cardiac output syndrome and multi-organ failure postoperatively. Case # 4 did not recover from profound shock that followed the preoperative acute myocardial infarction. The problems of low cardiac output syndrome caused by long interval of ischemic cardiac arrest, and also the problems of proximal anastomotic site of saphenous vein grafts were discussed.