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SYNCHRONOUS VS. STAGED CORONARY REVASCULARIZATION AND ABDOMINAL AORTIC ANEURYSM OPEN REPAIR: A SYSTEMATIC REVIEW
Konstantinos Spanos, Sr., Vasileios Salepsis, Nikolaos Roussas, Sr., Antonios Vouzas, Sr., Christos Argyriou, Sr., Athanasios Giannoukas, Sr., Professor.
University Hospital of Larissa, Larissa, Greece.

Objectives: Because the optimal management of patients with both symptomatic cardiac disease and large abdominal aortic aneurysm (AAA) still remains unclear, the outcome of synchronous (coronary artery bypass surgery-CABG and AAA open repair) vs. staged treatment was investigated.
Methods: electronic Pubmed search of the English literature was conducted. Age, CAD severity, AAA size, mean duration from coronary revascularization to AAA open repair, complications and death rate were analyzed.
Results: In the final analysis 14 studies (278 patients) with synchronous treatment and 8 studies (287 patients) with staged treatment that fulfilled the inclusion criteria were included. In total there were 37 early (30-day) deaths, accounting an 8.3% (23/278) 30-day mortality for synchronous treatment and 4.8% (14/287) for the staged treatment (p=0.14). From 14 deaths occurred in the staged treatment, 5 were due to AAA rupture happened16 up to 29 days after CABG. The 30-day cardiac complication rate was 13.66% (38/278) in the synchronous treatment and 1.4% (4/287) in the staged one (p<0.0001). The 30-day non-cardiac complication rate was 36% (100/278) in the synchronous treatment and 5.5% (16/287) in the staged one (p<0.0001).
Conclusions:The staged treatment appears to be associated with less mortality, though not significant, and significantly cardiac and non-cardiac morbidity as compared to synchronous treatment. Elective AAA open repair should be undertaken within first 2 weeks after CABG to eliminate mortality from rupture.


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