Repair of large abdominal aortic aneurysm should be performed early after coronary artery bypass surgery

Purpose: The surgical repair (coronary artery bypass grafting [CABG]) of sy mptomatic coronary artery disease (CAD) in patients with:co-existent large abdominal aortic aneurysm (AAA) may result in an increased rate of AAA rupt ure after operation. Simultaneous CABG/AAA. repair has been recommended by some surgeons, but with a somewhat higher mortality rate than staged repair . We reviewed the outcome of staged AAA repair that was performed early aft er CABG in patients with symptomatic coronary disease and AAA. Methods: The records of all the patients with symptomatic CAD that required CABG with large AAA (greater than 5 cm) were reviewed. In,most patients, C ABG was performed first, followed by AAA repair within 2 weeks, Patient dem ographics, severity of coronary disease, AAA size, interprocedure duration, and perioperative morbidity and mortality rates were examined. Results: Between 1991 and 1998, 1105 AAA repairs were performed. Within thi s group, 30 patients with AAA underwent CABG for symptomatic CAD. Mean AAA. size was 6.6 cm (range, 5.0-10.0 cm). The median interprocedure interval b etween CABG and AAA repair was 11.5 days. There was no in-hospital AAA rupt ure during this interval. The patient group was comprised of 24 men and 6 w omen with a mean age of 71 years. There was no operative death after such s taged AAA repair, and nonfatal complications occurred in seven patients (23 %). During this period, seven patients had AAA rupture when they were sent home after CABG for recovery and intended AAA repair at a later date. Conclusion: Staged elective AAA, repair may be performed safely and effecti vely after CABG, Performance of these procedures with a short interprocedur e interval may be preferable to the higher complication rate observed after :combined procedures.