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In-hospital outcomes of endovascular abdominal aortic aneurysm repair after previous myocardial revascularization for coronary artery disease
Journal: Russian Cardiology Bulletin. 2023;18(4): 41‑48
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To cite this article:
Akchurin RS, Shiryaev AA, Imaev TE, et al. . In-hospital outcomes of endovascular abdominal aortic aneurysm repair after previous myocardial revascularization for coronary artery disease. Russian Cardiology Bulletin.
2023;18(4):41‑48. (In Russ.)
https://doi.org/10.17116/Cardiobulletin20231804141
To evaluate the effectiveness of preliminary myocardial revascularization in patients with coronary artery disease (CAD) undergoing endovascular abdominal aortic aneurysm (AAA) repair.
A single-center retrospective study included 232 patients with CAD and AAA. Heart team determined feasibility, stages and details of surgical interventions. Patients were divided into 2 groups depending on myocardial revascularization strategy: group 1 — percutaneous transluminal angioplasty (PTA) with stenting as the first stage followed by endovascular aneurysm repair (EVAR) as the second stage (n=138; 59.5%); group 2 — coronary artery bypass grafting (CABG) at the first stage and EVAR at the second stage (n=94; 40.5%). We analyzed in-hospital results of EVAR in patients with AAA and CAD after previous myocardial revascularization.
Overall in-hospital mortality was 0.4% (group 1 — 0.7%, group 2 — 0). Incidence of perioperative ischemic events was 1.4% and 0%, respectively. We observed the following early postoperative adverse events: angina pectoris (n=1, 0.4%), myocardial infarction with fatal outcome (n=1, 0.4%), atrial fibrillation de novo (n=5, 2.2%), stent-graft thrombosis (n=4, 1.7%), stent-graft deformations requiring redo intervention (n=2, 0.9%), acute renal failure (n=5, 2.2%), endoleaks (n=42, 18.1%) including 3 (1.3%) severe ones requiring redo intervention (other endoleaks regressed within 6 months), pneumonia (n=2, 0.7%) and thromboembolic syndrome (n=1, 0.4%).
Preliminary myocardial revascularization before EVAR in patients with coronary artery disease and abdominal aortic aneurysm (indications for intervention in two vascular territories) is characterized by low overall mortality rate (0.4%). However, further research is required. Risk of perioperative myocardial ischemia is slightly higher in patients with undergoing EVAR after previous PTA compared to CABG (p=0.241; RR=1.01; OR=3.46). The overall incidence of complications was lower after PTA compared to CABG (p<0.05; OR=0.75; OR=0.54).
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Received:
30.06.2023
Accepted:
10.08.2023
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