Preoperative coronary artery bypass grafting in patients undergoing abdominal aortic reconstruction.

The effect of preoperative aortocoronary bypass grafting on the operative mortality of patients undergoing elective abdominal aortic reconstruction was examined by reviewing a series of 224 consecutive patients (1980 to 1983) (Group I) in whom selective preoperative noninvasive and invasive cardiac screening was used to identify patients with significant coronary stenoses. One patient died during cardiac catheterization. Twenty-seven patients (12 percent) underwent aortocoronary bypass grafting with one operative death (3.7 percent) and one nonfatal myocardial infarction (3.7 percent). These 26 patients subsequently underwent abdominal aortic reconstruction with no mortality and no postoperative myocardial infarction. One hundred ninety-six patients (88 percent) underwent aortic reconstruction without prior aortocoronary bypass grafting with four operative deaths (2 percent), including two fatal myocardial infarctions. The combined operative mortality for Group I patients was 2.3 percent. Three hundred twenty-six patients (Group II) who underwent abdominal aortic reconstruction at this institution from 1970 to 1976 had an 8 percent operative mortality, of which 50 percent of the deaths were due to myocardial infarctions (Group I versus Group II, p less than 0.01). Selective preoperative screening for coronary artery disease in patients undergoing elective abdominal aortic reconstruction with aortocoronary bypass grafting in selected patients is safe and may help reduce the operative mortality.