Surgical treatment of thoracic aortic aneurysm in patients with concomitant coronary artery disease.
OBJECTIVE
Surgical treatment of thoracic aortic surgery in patients with coronary artery disease was investigated.


METHODS
Between 1990 and April 2003, 330 patients underwent elective thoracic aortic surgery. Fifty-six patients who underwent aortic root reconstruction were excluded and 274 patients were examined. Fifty-four (20%) patients showed concomitant coronary artery disease. Ten had undergone coronary revascularization previously; and 3 underwent coronary revascularization [2 coronary artery bypass grafting (CABG), 1 percutaneous transluminal coronary angioplasty (PTCA)] before aortic surgery. Twenty-three patients underwent elective CABG simultaneously and 2 patients had additional coronary artery bypass because of cardiac ischemia during operation. The number of patients who underwent thoracic aortic surgery including Asc Ao+AVR was 2, hemi arch 1, total arch 15, distal arch 5, distal arch+LV aneurysmectomy 1, and thoracoabdominal Ao 1. Two patients underwent coronary revascularization with arterial grafts and the others with SVG grafts.


RESULTS
There was one hospital death (4%). In patients without coronary bypass, 2 patients suffered cardiac ischemic events.


CONCLUSIONS
Our thoracic aortic operations with concomitant CABG using SVG were overall successful. Our current strategies for thoracic aortic surgery in patients with concomitant coronary artery disease include conducting a dipyridamole myocardial perfusion-imaging test first in patients not at risk of coronary artery disease, and if the test is positive, coronary angiography is performed and aggressive coronary revascularization is conducted where possible.
Nakai
Masanao
M
Section of Cardiovascular Surgery, Shizuoka City Hospital, Shizuoka, Japan.
Shimamoto
Mitsuomi
M
Yamasaki
Fumio
F
Fujita
Shoji
S
Masumoto
Hidetoshi
H
Yamada
Tetsu
T
Nakajima
Daisuke
D
Hamaji
Masatsugu
M
D000368:Aged; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000150:complications* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male