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Eur J Cardiothorac Surg 2002;23:532-536
© 2002 Elsevier Science NL

Aortic stent-grafting: successful introduction into the combined procedure for coronary artery bypass grafting and aortic aneurysm repair

^a Clinic for Cardiovascular Surgery, University Hospital Zurich, 100 Rämistrasse, CH-8091 Zurich, Switzerland
^b Oxford Heart Centre, University of Oxford, Oxford, UK
^c Department of Radiology, University Hospital Zurich, 100 Rämistrasse, CH-8091 Zurich, Switzerland
^d Institute of Anesthesia, University Hospital Zurich, 100 Rämistrasse, CH-8091 Zurich, Switzerland

Received 7 October 2002; received in revised form 11 December 2002; accepted 16 December 2002.

^* Corresponding author. Tel.:+41-1-255-1111; fax: +41-1-255-5715
e-mail: mario.lachat{at}chi.usz.ch

Objectives: Coronary artery bypass grafting (CABG) and combined stent-grafting (SG) were evaluated to reduce morbidity and mortality of patients with descending or infrarenal aortic aneurysm. Methods: CABG and SG (thoracic n=6, infrarenal n=36) were performed during the same hospitalization in 42 patients (mean age of 73±14 years). In 29 patients (mean Euroscore: 9), SG was performed under local anesthesia 9±3 days after coronary surgery (simultaneous) and in 13 patients (mean Euroscore: 7) during the same anesthesia (synchronous). In the latter group, 11 out of 13 patients underwent off-pump CABG. All aneurysms were treated by implantation of commercially available self-expanding grafts. Results: CABG was successful in all, but one patient with left internal mammary artery hypoperfusion syndrome, requiring an additional distal saphenous graft to the left anterior descending coronary artery. SG was uneventful in 98% (41/42 patients). Postoperative computerized tomography showed incomplete sealing in seven patients (17%), but only the two attachment endoleaks had to be treated by one proximal and one distal SG extension. Overall hospital stay for the synchronous repair was 12.5±6 days and that of the simultaneous group 17.5±7 days. Thirty-day mortality was 5% (2/42) as one patient of the simultaneous group experienced a lethal cerebral embolism during SG and one patient of the synchronous group developed an untreatable infection. In the follow-up of 4 years, there were two vascular reinterventions but no additional procedure-related morbidity or mortality. Conclusions: This experience shows that combined CABG and SG of thoracic or infrarenal aortic aneurysm is a safe and less-invasive alternative to the open graft repair, especially in the older patients or patients with severe comorbidities.

Key Words: Coronary artery bypass grafting • Beating heart • Off-pump • Combined procedure • Aortic aneurysm • Stent-grafting