Liverpool Heart and Chest Hospital, Liverpool, UK.
J Endovasc Ther. 2013 Jun;20(3):345-9. doi: 10.1583/12-3966R.1.
To report an initial experience of concomitant endovascular repair of abdominal aortic aneurysms (AAA) and cardiac surgery.
Records for 10 consecutive patients (all men; median age 68 years, range 60-79) with AAA treated by a multidisciplinary team at a tertiary specialist center were retrospectively reviewed. Each patient had independent indications for surgical correction of their cardiac disease and AAAs. The patients underwent endovascular aneurysm repair (EVAR) followed by cardiac surgery under the same anesthesia. Eight patients had concomitant coronary artery bypass grafting (CABG; 4 off-pump), 1 patient had CABG and left ventricular aneurysmectomy, and 1 patient required aortic root replacement.
All combined procedures were performed successfully under a single general anesthesia and took a median of 508 minutes (range 425-625). Median intensive care stay was 3 days (range 2-4), while hospital stay was 8 days (range 7-21) days. There were no deaths in-hospital or within 30 days. Complications were minor and self-limiting; there were no instances of renal failure. At a median follow-up of 29 months (range 14-38), no EVAR-related secondary interventions were required.
Concomitant EVAR and cardiac surgery delivered by a multidisciplinary team is feasible, appears safe, and eliminates the risk associated with staged operations. Improved patient satisfaction and efficient use of resources are potential advantages.
报告多学科团队同时治疗腹主动脉瘤（AAA）和心脏手术的初步经验。
回顾了在三级专科中心由多学科团队治疗的 10 例连续患者（均为男性；中位年龄 68 岁，范围 60-79 岁）的记录。每位患者均有独立的心脏疾病和 AAA 手术矫正指征。患者接受了血管内动脉瘤修复（EVAR），然后在同一麻醉下进行心脏手术。8 例患者同时行冠状动脉旁路移植术（CABG；4 例非体外循环），1 例患者行 CABG 和左心室瘤切除术，1 例患者需要主动脉根部置换术。
所有联合手术均在单一全身麻醉下成功完成，中位时间为 508 分钟（范围 425-625）。中位重症监护时间为 3 天（范围 2-4），而住院时间为 8 天（范围 7-21）。院内和 30 天内无死亡。并发症轻微且自限性；无肾衰竭。中位随访 29 个月（范围 14-38），无需进行 EVAR 相关的二次介入。
多学科团队同时进行 EVAR 和心脏手术是可行的，似乎是安全的，并消除了分期手术相关的风险。提高患者满意度和有效利用资源是潜在的优势。
