Cardiac investigation and intervention prior to thoraco-abdominal aneurysmrepair: Coronary angiography in 35 patients

Objective: retrospective studies indicate a high risk of cardiac events in patients undergoing thoraco-abdominal aneurysm repair. We aimed to determin e the prevalence of coronary disease in these patients, define the role of non-invasive cardiac testing and assess the short-term outcome of coronary re-vascularisation. Design: a prospective cohort study of consecutive patients referred to a si ngle surgeon. Materials and Methods:forty patients recruited over 26 months (Type I, 6; I I, 11; III, 8; IV, 15). Dobutamine stress echocardiography coronary angiogr aphy and coronary re-vascularisation (PTCA or CABG) were performed accordin g to a pragmatic protocol. Main outcome measures mere the prevalence of cor onary artery disease, sensitivity and specificity of clinical assessment an d non-invasive cardiac testing, and adverse events associated with coronary investigation and intervention. Results: seven patients (17.5%) were stratified as having high perioperativ e cardiac risk. The majority of patients (23, 57.5%) had no cardiac risk fa ctor other than the operation type. Five patients (12.5%) had inducible isc haemia on non invasive testing. Fourteen patients (40%) had haemodynamicall y significant coronary artery stenoses, of whom 12 (34%) underwent coronary revascularisation. Dobutamine stress echocardiography demonstrated 100% sp ecificity and 71% sensitivity for the detection of significant coronary art ery lesions. Coronary re-vascularisation by three-vessel bypass grafting wa s complicated by non-fatal stroke in one patient. Thirty-five patients (87. 5%) proceeded to aneurysm repair. No patient who had been adequately invest igated suffered a cardiac complication. Conclusions: the 40% prevalence of coronary artery disease in these patient s is comparable to that of other patients undergoing arterial surgery. Non- invasive testing proved beneficial, both in screening low-risk patients and planning intervention in patients at higher risk. An aggressive approach t o intervention was associated with art acceptable complication rate and fav ourable short-term outcome.