Combined surgical treatment of patients with huge aortic abdominal aneurysms associated with coronary artery lesions

The objective of this study was to define the perioperative risk of simultaneous operations in patients with abdominal aortic aneurysm (AAA) associated with coronary artery disease (CAD). The hospital data of 30 patients with coexistent severe symptomatic AAA and significant CAD, who underwent one stage surgery of the abdominal aorta and the coronary arteries was retrospectively analysed. Most of the pts.--28 were male and only 2 female. The average age consisted 57.7 years. Infrarenal AAA (diameter over 5 cm) was presented in 25 patients and suprarenal extension was in presented in 5 pts, while all patients with coexisting CAD had three vessels disease and significant impairment of left ventricular function (23 pts with ejection fraction (EF) < 50% and 10 pts < 30% EF). The resections of AAA in pts. undergoing simultaneous coronary artery procedure were performed on cardiopulmonary bypass (CPB) and moderate hypothermia. There were 2 early postoperative deaths (6.66%) and 5 major nonfatal postoperative complications (16.6%). Our experience with simultaneous surgery of coexistent huge AAA and CAD demonstrated that: a) Combined procedure can be performed safely in patients with significant AAA and CAD. b) The overall early operative mortality and morbidity after combined surgery compare favourably with the results after CABG of patients with impaired left ventricular function. c) Simultaneous operation seems to be more favourable in patients with coexistent AAA and CAD regarding the high risk of aneurysmal rupture, saving them also the potential morbidity and eventually fatal complications associated with the second procedure. d) Even the management of suprarenal and huge infrarenal AAA can be carried out easier and with less risk of complications under the protection of CPB.