A single centre experience of simultaneous open abdominal aortic aneurysm and cardiac surgery☆

Abstract

Controversy exists over the optimal management of patients with both symptomatic cardiac disease and significant abdominal aortic aneurysm (AAA), but who are unsuitable for endovascular treatment for either pathology. We present our single centre series of synchronous cardiac and aortic aneurysm surgery in patients anatomically unsuitable for endovascular AAA repair. All patients undergoing synchronous cardiac and open AAA surgery between June 2002 and December 2008 were analysed using a prospectively maintained database supplemented with case note review. Thirteen patients with a median age of 78 years underwent combined surgery. Two AAA were juxtarenal and the remainder infrarenal with a median diameter of 7 cm (4.8-11), of which three were symptomatic. In all cases, endovascular repair was not possible due to either hostile iliac or neck anatomy. Eleven patients underwent coronary artery bypass grafting (CABG), one CABG plus aortic valve replacement and one patient aortic valve replacement only. All patients were operated on cardiopulmonary bypass (CPB) and received autologous cell salvaged blood. Median CPB and operative time was 182 (141-260) and 420 (360-490) min, respectively. There were two deaths: the first after 90 days from multi-organ failure and stroke, the second following three days from multi-organ failure. Complications comprised: four transient renal impairment; one transient jaundice; four pneumonia; one unstable sternum; and four arrhythmias with one patient requiring a permanent pacemaker. Two patients suffered transient diarrhoea but no other features of intestinal ischaemia. The remaining 11 patients are alive with a median New York Heart Association (NYHA) score improvement from III to II at six months. Simultaneous open repair of AAA and cardiac surgery is a feasible option for this high-risk and anatomically challenging patient group. This experience highlights the need for close cooperation between vascular and cardiac teams.