title: Surgical treatment of thoracic aortic aneurysm in patients with concomitant coronary artery disease.
abstract: 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.
authors.affiliation: Section of Cardiovascular Surgery, Shizuoka City Hospital, Shizuoka, Japan.
authors.forename: Masanao
authors.initials: M
authors.lastname: Nakai
authors.forename: Mitsuomi
authors.initials: M
authors.lastname: Shimamoto
authors.forename: Fumio
authors.initials: F
authors.lastname: Yamasaki
authors.forename: Shoji
authors.initials: S
authors.lastname: Fujita
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Masumoto
authors.forename: Tetsu
authors.initials: T
authors.lastname: Yamada
authors.forename: Daisuke
authors.initials: D
authors.lastname: Nakajima
authors.forename: Masatsugu
authors.initials: M
authors.lastname: Hamaji
mesh_terms: 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