PMID- 19854792
OWN - NLM
STAT- MEDLINE
DCOM- 20100128
LR  - 20091218
IS  - 1569-9285 (Electronic)
IS  - 1569-9285 (Linking)
VI  - 10
IP  - 1
DP  - 2010 Jan
TI  - A single centre experience of simultaneous open abdominal aortic aneurysm and 
      cardiac surgery.
PG  - 63-6
LID - 10.1510/icvts.2009.219105 [doi]
AB  - OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 
      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.
FAU - Kordowicz, Andrew
AU  - Kordowicz A
AD  - Department of Vascular Surgery, University Hospital of South Manchester NHS 
      Foundation Trust, Southmoor Road, Manchester M23 9LT, UK.
FAU - Ghosh, Jonathan
AU  - Ghosh J
FAU - Baguneid, Mohamed
AU  - Baguneid M
LA  - eng
PT  - Journal Article
DEP - 20091023
PL  - England
TA  - Interact Cardiovasc Thorac Surg
JT  - Interactive cardiovascular and thoracic surgery
JID - 101158399
SB  - IM
MH  - Aged
MH  - Aortic Aneurysm, Abdominal/complications/mortality/*surgery
MH  - Blood Transfusion, Autologous
MH  - *Blood Vessel Prosthesis Implantation/adverse effects/mortality
MH  - Cardiopulmonary Bypass
MH  - *Coronary Artery Bypass/adverse effects/mortality
MH  - Female
MH  - Heart Diseases/complications/mortality/*surgery
MH  - *Heart Valve Prosthesis Implantation/adverse effects/mortality
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Patient Care Team
MH  - Retrospective Studies
MH  - Severity of Illness Index
MH  - Time Factors
MH  - Treatment Outcome
EDAT- 2009/10/27 06:00
MHDA- 2010/01/29 06:00
CRDT- 2009/10/27 06:00
PHST- 2009/10/27 06:00 [entrez]
PHST- 2009/10/27 06:00 [pubmed]
PHST- 2010/01/29 06:00 [medline]
AID - icvts.2009.219105 [pii]
AID - 10.1510/icvts.2009.219105 [doi]
PST - ppublish
SO  - Interact Cardiovasc Thorac Surg. 2010 Jan;10(1):63-6. doi: 
      10.1510/icvts.2009.219105. Epub 2009 Oct 23.