SIMULTANEOUS CORONARY-BYPASS AND ABDOMINAL AORTIC-SURGERY IN PATIENTSWITH SEVERE CORONARY-DISEASE - INDICATION AND RESULTS

In patients with severe coronary artery disease (CAD) abdominal aortic surgery is still associated with high morbidity and mortality rates. Some patients will present with both symptomatic CAD and large, sympto matic abdominal aortic aneurysms (AAA) or end-stage aortic occlusive d isease (AOD) that does not allow for a two-stage procedure. We report a series of 29 patients who underwent simultaneous coronary artery byp ass graft surgery (CABG) and abdominal aortic surgery (25 AAA, 4 AOD). In the AAA group there were 23 males and 2 females with a mean age of 68 years (50-80). Sixteen patients presented with severe three-vessel disease. Ten patients had unstable angina. Aortic stenosis or insuffi ciency was present in two and one patient, respectively. Four patients with three-vessel disease and an ejection fraction below 30% presente d with end-stage AOD and critical limb ischemia. Coronary bypass graft surgery was performed first. With the patient still on partial cardio pulmonary bypass, abdominal aortic surgery was carried out. Patients r eceived an average of 3.1 coronary bypass grafts. Additionally, three aortic valves were implanted. Fourteen tube grafts and 15 bi-iliacal o r bifemoral bifurcation grafts were placed in the abdominal aortic pos ition. Additional vascular surgery was performed in five patients. Int raoperative management was without complication in all but one patient , who had intraoperative myocardial infarction (AOD group). Hospital m ortality was 8% (2/25) in the AAA group. There was however substantial hospital morbidity (52.2%). The mean follow-up is 20.5 +/- 2.5 months . The actuarial survival rate at 3 years is 84.9%. It is concluded tha t combined CABG and abdominal aortic surgery is a reasonable option fo r patients who present with both severe CAD and symptomatic abdominal aortic disease. The continuation of CPB during aortic surgery may effe ctively prevent the adverse effects of infrarenal aortic clamping on a failing ventricle.