Combined coronary artery and abdominal aortic surgery - without cardiopulmonary bypass

To determine the effects of bearing heart surgery on patients undergoing simultaneous coronary artery bypass grafting and abdominal aortic surgery, we performed such surgery on 20 patients (mean age, 64.55 +/- 7.96 SD years). Abdominal aortic disease was defined as an abdominal aortic aneurysm larger than 5 cm in diameter or as end-stage aortic occlusive disease. Hemodynamic measurements, inotropic requirements, and incidence of perioperative myocardial infarction and arrhythmias were recorded, as were subsystem clinical outcomes length of intensive care unit and hospital stays, blood loss, and transfusion requirements. There was no,incidence of death, perioperative myocardial infarction, stroke, or acute renal failure. The mean number of grafts per patient was 1.95 +/- 0.69. Only 4 minor postoperative complications were observed: three patients (15%) had evidence of supraventricular tachyarrhythmias, and 1 patient (5%) had chest infection that required a longer-than-average intubation period. Six patients (30%) required minimal-to-moderate inotropic support. The mean blood loss was 673 +/- 246.8 mt and transfusion requirements were low. The mean intensive care unit and hospital lengths of stay were 2.12 +/- 0.33 days and 7.08 +/- 1.44 days, respectively. Clinical follow-up (mean, 10 months) showed all patients to be in New York Heart Association functional class I or II with no late cardiac or abdominal events. We conclude that simultaneous coronary artery bypass grafting and abdominal aortic surgery on the beating heart is safe and effective, and has a low perioperative clinical morbidity rate. To our knowledge, ours is the Ist report on this procedure. Larger studies with longer follow-up are needed.