Cardiac Surgery for Takayasu's Disease

(Department of Cardiovascular Surgery, Toyama Prefectural Central Hospital, Toyama, Japan)

Yukihisa Isomatsu Hiroyuki Tsukui Shuichi Hoshino
Yasushi Nishiya
Eight patients with Takayasu's disease underwent cardiac surgery between 1983 and 1998. All were women and the age at the time of operation ranged from 42 to 68 years (mean, 53.8 years). They were divided into two groups according to the coronary artery involvement: group A (n3) had aortic regurgitation with an intact coronary artery and underwent aortic valve replacement (AVR); group B (n5) had coronary artery lesion and underwent coronary artery bypass grafting (CABG) concomitant with or without AVR. All AVR procedures were performed using mechanical valves. At the CABG operation, saphenous veins alone were used in three cases and the left internal thoracic artery and saphenous veins in two. The actuarial survival rate was 65.6% at 5 years and 32.8% at 10 years. There were no early or late deaths in group A. On the contrary, there were one hospital death and two late deaths in group B. We discussed the timing of surgical intervention, the kind of prosthetic valve, the material of bypass graft and the procedure of CABG, the postoperative steroid use, and the surgical prognosis. The optimal timing of surgery for cardiac involvement is, needless to say, the inactive phase of inflammation. However, there are some patients who require operations during the active phase because of medically intractable or worsening symptoms. There is a consensus regarding the kind of prosthesis, and the mechanical valve is usually employed. There are still controversies regarding the material of grafts. We do not know the late results of saphenous vein graft in Takayasu's disease although saphenous vein is thought to be the choice of graft and several CABG procedures are advocated. The left internal thoracic artery might be used as a graft if the patient with Takayasu's disease had no subclavian artery lesions and was stable with an antiinflammatory regimen. We recommend the postoperative steroid therapy to control inflammation and also describe the antiinflammatory regimen after cardiac surgery in Takayasu's disease. It is essential that we have to meticulously follow up the patients with Takayasu's disease who underwent cardiac operations, paying especial attention to the side effects of steroid as well as the progression of inflammation.
@Jpn. J. Cardiovasc. Surg. 30: 15-18 (2001)