|Strategy for Abdominal Aortic
Aneurysm Repair in Patients with Ischemic Heart Disease
(Department of Cardiovascular Surgery, Itabashi
Chuo Medical Center, Tokyo, Japan and Department of Cardiovascular
Surgery, Jichi Omiya Medical Center*, Saitama, Japan)
|Abdominal aortic aneurysms (AAA)
are frequently associated with clinically significant coexistent
ischemic heart disease (IHD). Cardiac events are the most common
cause of death after AAA repair. Preoperative coronary evaluation
and revascularization have been recommended to reduce postoperative
cardiac complications following AAA repair. In this study, we
retrospectively reviewed all patients who underwent AAA repair
and compared operative results in patients with and without IHD.
Of 388 patients who underwent elective AAA repair, 382 (98.5%)
had aortography and coronary angiography for preoperative evaluation.
Significant coronary artery disease was seen in 124 patients
(32.5%). As a result of the evaluation, 46 patients (12.0%jwere
considered candidates for medical therapy, 18 for percutaneous
coronary intervention (PCI), and 60 for coronary artery bypass
grafting (CABG). In 24 patients (6.3%) who needed CABG and had
large sized AAAs (60mm), simultaneous CABG and AAA repair were
performed. In the remaining 36 patients (9.4%) who needed CABG
and had medium sized AAAs (40mm, 60mm), staged operation was
performed. We performed retrospective review comparing postoperative
cardiac events and operative mortality among these treatment
groups. There were 5 operative deaths (5/388, 1.3%) in patients
following AAA repair. There were 2 operative deaths (2/124, 1.6%)
in patients with significant IHD and 3 deaths (3/258, 1.2%) without
IHD. In patients with IHD, 1 patient who received medical therapy
died of acute renal failure and another one who received PCI
died of acute myocardial infarction. There were no operative
deaths or cardiac-related events in patients who received CABG
before or concomitant AAA repair. There was only 1 cardiac-related
event in all patient groups following AAA repair. Coronary arteries
were preoperatively evaluated in almost all patients with AAA.
If IHD was significant, the treatment for the IHD preceded AAA
repair. Our strategy succeeded in reducing operative mortality
and cardiac-related events in patients with both AAA and IHD.
If a patient with a large sized AAA (60mm) needs CABG, one-stage
operation is recommended.
@Jpn. J. Cardiovasc. Surg. 33: 73-76 (2004)