OPTIMAL TIMING OF ABDOMINAL AORTIC-ANEURYSM REPAIR AFTER CORONARY-ARTERY REVASCULARIZATION

Objective The authors ascertained the optimal timing oi repair of an a bdominal aortic aneurysm (AAA) after coronary artery revascularization . Summary Background Data Cardiac events are the most common cause of death after elective repair of AAA. Preoperative coronary revasculariz ation has significantly reduced postoperative cardiac complications af ter elective AAA repair. Currently, most patients undergo repair of as ymptomatic AAA within 6 months after the coronary revascularization. M ethods The authors performed a retrospective review of patients who un derwent repair or scheduled repair of an asymptomatic AAA within 6 mon ths after coronary artery bypass graft (CABG) between March 1988 and O ctober 1993. Results There was no mortality in the group oi patients ( n = 14) who underwent repair of AAA simultaneously or within 14 days o f coronary revascularization. In contrast, there was a significantly i ncreased mortality rate of 3 of 9 (33%) in patients scheduled to under go repair of the AAA more than 2 weeks after coronary revascularizatio n (p < 0.05). All nonsurvivors died between 16 and 29 days after CABG, and died as a result of ruptured AAA. Conclusion Elective AAA repair should be undertaken simultaneously or within 2 weeks of coronary arte ry revascularization because of an increased risk of postoperative AAA rupture seen after this time period. In addition, simultaneous or ear ly postoperative AAA repair does not increase the overall operative ri sk.