One-Stage Coronary Bypass and Abdominal Aortic Aneurysm Repair
A group of 29 patients with simultaneous coronary disease and abdominal aortic aneurysm were treated following two protocols: Group I, 16 patients had coronary bypass surgery and then abdominal aortic aneurysm repair at a later date. This required two hospitalizations and two separate surgeries. Group II, 11 patients, underwent coronary bypass surgery and repair of abdominal aortic aneurysm (AAA) in one sitting. Group III, 2 patients, had PTCA prior to AAA repair. There were 3.1 bypass grafts implanted (Group I), vs 2.9 (Groups II) (ns). All abdominal aneurysms were infrarenal and 22 patients had straight tube graft replacement (76%), and seven bifurcated grafts. Two patients with angina also had symptomatic AAA. Period of hospitalization, morbidity, mortality, time of total recovery, hospital costs, and apprehension of patients were analyzed. There was one death in Group I. In this group, the total recovery time was 4.8 months vs 2.4 months for Group II. Hospitalization time was 16.2 days in Group I vs 8.2 days in Group II. The hospital costs were significantly higher in Group I with an average of $58,950 vs $46,553 in Group II. No deaths occurred in Group II. It is recommended that if a patient with severe coronary disease requiring surgery also presents with an AAA of more than 5 cm, he/she should have both conditions operated on in one session rather than staggering the procedures. It saves time, cost, anxiety, and is well tolerated.
Molina
JE
Department of Surgery, University of Minnesota, Minneapolis, Minnesota