Selection of surgical strategy for abdominal aortic aneurysm coexisting with coronary artery disease; one-stage versus two-stage, and off-pump versus on-pump

• Published in: Kyobu geka. The Japanese journal of thoracic surgery Vol. 56; no. 8 Suppl; p. 619
• Main Authors: Endo, M, Aomi, S, Tomisawa, Y, Uchikawa, S, Kihara, S, Yamasaki, K, Nishida, H, Kurosawa, H
• Format: Journal Article
• Language: Japanese
• Published: Japan 01-07-2003
• Subjects: Aged; Aortic Aneurysm, Abdominal - complications; Aortic Aneurysm, Abdominal - surgery; Cardiopulmonary Bypass - mortality; Coronary Artery Bypass - methods; Coronary Artery Bypass - mortality; Coronary Artery Disease - complications; Coronary Artery Disease - surgery; Female; Follow-Up Studies; Humans; Male; Middle Aged; Patient Selection; Reoperation - mortality; Retrospective Studies; Survival Rate; Treatment Outcome; Vascular Surgical Procedures - methods; Vascular Surgical Procedures - mortality
• ISSN: 0021-5252

In patients having a combination of severe coronary artery disease (CAD) and expanding abdominal aortic aneurysm (AAA), one-stage operation of simultaneous coronary artery bypass grafting (CABG) and AAA repair has been recommended.
Of 96 patients (94 men, average 65 year) with AAA and CAD, 21 patients underwent one-stage operation of simultaneous CABG and AAA repair (Group A-1: off-pump CABG in 10 and on-pump in 11), and 75 underwent two-stage operation of CABG followed by AAA with an interval of less than 6 months in 23 patients (Group A-2) and more than 6 months in 52 patients (Group B). Baseline characteristics were similar between the one-stage and two-stage groups, and off-pump and on-pump subgroups, except the proportion of single vessel disease. Mean number of distal anastomoses was significantly lower in the off-pump subgroup than in the on-pump subgroup (p = 0.011) and the two-stage group (p = 0.0057). There was 1 hospital death among on-pump patients but none among off-pump patients. Mortality rate was 4.8% in the one-stage group. Two patients (8.7 &) in the two-stage group, who had AAA was 7.0 cm and 7.5 cm diameter, died of AAA rupture prior to repair. The 10-year all death free rates were 44% in Group A (A-1 and A-2), and 86% in Group B (p = 0.0004).
Our data suggest that one-stage operation with off-pump CABG is an attractive option in selected patients with a large AAA (> 7 cm).