Importance of cardiovascular interventions before surgery for abdominal aortic aneurysms

Preoperative screening, and interventional and surgical therapy of cardiova scular diseases are of pivotal importance for successful outcome after abdo minal aortic aneurysm surgery. In a retrospective study, all patients who u nderwent surgery for abdominal aortic aneurysm were reevaluated by preopera tive diagnostic and therapeutic interventions for cardiovascular disease. T wo study periods (1980-1989 and 1990-1996) were compared. Of 603 patients o perated upon for abdominal aortic aneurysm between 1980 and 1996, 449 had s urgery on an elective basis and 154 as an emergency. Preoperative diagnosti c studies for coronary artery disease were performed on elective patients a nd were positive in 76.8% (1980-1989, 76.1%, 1990-1996, 77.5%). Coronary an giography was performed in 108 patients (29.6%). Medical therapy of coronar y artery disease declined by 2.3%, and interventional procedures by 18.8%. In contrast, myocardial revascularization with subsequent aneurysm resectio n increased by 26.6% and 12 patients (16%) required urgent simultaneous car diac and aortic surgery. Early mortality after abdominal aortic aneurysm su rgery decreased from 4.2 to 2.9%, and the frequency of primary cardiac fail ure as the cause of death was reduced from 33.3 to 22.2% (P < 0.05). It was concluded that 42.6% more cardiac surgical procedures were performed befor e abdominal aortic aneurysm surgery since 1990 compared with the period 198 0-1989. In contrast, the number of interventional procedures fell by 18.8%. Surgical therapy of cardiac disease reduces early mortality after elective abdominal aortic aneurysm surgery. (C) 2000 The International Society for Cardiovascular Surgery, Published by Elsevier Science Ltd. All rights reser ved.