USE OF CORONARY ARTERIOGRAPHY IN THE PREOPERATIVE MANAGEMENT OF PATIENTS UNDERGOING URGENT REPAIR OF THE THORACIC AORTA

Noninvasive innovations have advanced the timing and precsion of diagnosis of acute dissection or enlarging aortic aneurysm. However, the need to perform coronary arteriography prior to surgical repair in these patients remains a question for many clinicians. This retrospective 10-year (1978 to 1988) review examined data of 54 patients undergoing urgent surgical repair of thoracic aortic tear, aneurysm, or dissection in our institution. Results of coronary arteriography and clinical variables (history of coronary artery disease, electrocardiographic abnormalities, surgical procedures, and in-hospital mortality) were tabulated. Twenty-seven patients had type A aortic dissection and 27 patients had type B. Twenty-four patients had aortic dissection or tear (type A or B) due to motor vehicle trauma. In patients with type A, a history and/or electrocardiogram suggestive of coronary artery disease was present in 16, in whom cardiac catheterization was performed in five. None required coronary bypass surgery or died. In the 11 patients with no clinical history of coronary artery disease or electrocardiographic abnormalities, six had cardiac catheterization, none had coronary artery disease, two had coronary reimplantation, and six died. Only 1 of the 27 patients with type A dissection had a perioperative myocardial infarction (a patient with a clinical history of coronary artery disease who did not undergo cardiac catheterization). In patients undergoing type B aortic repair, 10 had a clinical history or electrocardiogram consistent with coronary artery disease but only one underwent cardiac catheterization and subsequent coronary artery bypass graft surgery for coronary artery disease. Seventeen patients had no history of coronary artery disease, of whom only two had cardiac catheterization (no coronary artery disease, no deaths), with three deaths in the remaining 15-one with coronary artery disease found at autopsy. Death after aortic surgical repair in our series was most often due to postoperative bleeding complications without evidence of myocardial infarction. In patients with no prior history of coronary artery disease of electrocardiographic abnormalities, past and current surgical experience do not support routine use of coronary arteriography. © 1990 Mosby-Year Book, Inc.