One-Stage Surgery of Coronary Arteries and Abdominal Aorta in Patients With Impaired Left Ventricular Function

Abstract

One-stage surgery is a possible approach to highly symptomatic patients with severe multivascular disease and has acceptable early morbidity and mortality. Patients with severely impaired left ventricular function and unstable CAD carry a high risk of left heart failure and/or myocardial infarction during abdominal aortic surgery. Extracorporeal circulation protects the heart from the hemodynamic changes after aortic clamping or declamping during abdominal aortic surgery. The present study demonstrates that one-stage procedure is a reasonable option for this patient subgroup.

A rare case of giant coronary artery aneurysm in the context of multiple arterial aneurysms

“…Most studies suggest intervening in two stages, with surgical repair of CAA first then AAA intervention, whilst others advise concurrent surgery for both pathologies. 13 …”

Combined complex open heart surgery and infra-renal aortic aneurysm repair

“…Although some authors [2,3] have anecdotally mentioned, one-stage surgical treatment of combined infra-renal abdominal aneurysm, severe ischemic cardiomyopathy and aortic regurgitation challenged us. A combined operation was indicated based on a large aortic aneurysm with impending rupture in a patient with advanced ischemic heart disease and poor left ventricular function.…”

“…Although some authors [2,3] have advocated the aortic aneurysm repair after heart surgery still on cardiopulmonary bypass, we decided to allow the heart to recover before proceeding with aneurysm repair in order to minimize the duration of cardiopulmonary bypass. Post pump heart function tolerated well the effects of prolonged cardioplegic arrest and risk of aortic clamping.…”

Combined Coronary Artery Bypass Grafting on the Beating Heart and Abdominal Aortic Aneurysm Repair

“…In patients with complications, impaired left ventricular function, poor respiratory function and/or renal failure, the mortality rate of combined surgery with CPB under cardiac arrest is reported to be 0-25%. [20][21][22][23] The patients at highest risk for undergoing CPB, including those of advanced age and having ventricular dysfunction, are precisely those for whom OPCABG may be the most useful. OPCABG also reduces hospital cost, the length of postoperative stay and morbidity compared with CABG on CPB, and is safe and effective.…”