Development of cardiovascular procedures before abdominal aortic aneurysm repair over 16 years.

Background: Preoperative screening, interventional and surgical therapy of cardiovascular diseases are of pivotal importance for a successful outcome after abdominal aortic aneurysm (AAA) surgery.

Methods: In a retrospective study all patients who underwent surgery for AAA were reevaluated for preoperative diagnostic and therapeutic interventions for cardiovascular diseases. Two study periods 1980-1989 and 1990-1996 were defined. Of 603 patients operated upon because of AAA between 1980 and 1996, 449 were operated on an elective basis and 154 as an emergency. Preoperative diagnostic studies for coronary artery disease (CAD) were performed in electively operated patients only and were positive in 76.8% (1980-1989: 76.1%, 1990-1996: 77.5%). Coronary angiography was performed in 108 patients (29.6%). Medical therapy of CAD declined by 2.3%, interventional procedures by 18.8%. In contrast, myocardial revascularization with subsequent aneurysm resection increased by 26. 6% and 12 patients (16%) required urgent simultaneous cardiac and aortic surgery. Early mortality after AAA surgery dropped from 4.2% to 2.9%, the frequency of primary cardiac failure as the cause of death was reduced from 33.3% to 22.2% (p < 0.05).

Conclusions: 42.6% more cardiac surgical procedures were performed before AAA surgery since 1990 compared with the period 1980-1989. In contrast, the number of interventional procedures fell by 18.8%. Surgical therapy of cardiac disease reduces early mortality after elective AAA surgery.