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Long-term Outcomes Of Surgical Treatment For Coronary Artery Aneurysms
KEN CHEN, MASATERU UCHIYAMA, TOMOHIRO IMAZURU, TOMOKI SHIMOKAWA.
TEIKYO UNIVERSITY, Itabashi-ku, TOKYO, Japan.
Objective: Coronary artery aneurysm (CAA) is a relatively rare condition, typically asymptomatic and often detected incidentally through imaging modalities such as computed tomography or echocardiography. Its prevalence among patients undergoing coronary angiography ranges from 0.3% to 4.9%. However, a standardized consensus on optimal surgical management has not been established. At our institution, surgical strategy is determined based on aneurysm size: revascularization alone is performed for aneurysms <20 mm to prevent thromboembolism, while aneurysms ≥20 mm are treated with both revascularization and aneurysm resection to prevent rupture. In this study, we aimed to evaluate the long-term outcomes of surgical treatment for CAA performed at our center.
Methods: We retrospectively reviewed 11 patients who underwent surgical intervention for CAA between October 2009 and December 2023. In addition to aneurysm diameter, factors influencing the decision to perform resection included rapid expansion, post-percutaneous coronary intervention status, and saccular morphology. Kawasaki disease-related aneurysms were managed conservatively. Clinical outcomes were analyzed using the Kaplan-Meier method to estimate overall survival and freedom from major adverse cardiovascular and cerebrovascular events (MACCE).
Results: The mean age of patients was 55.5 ± 20.9 years, and 10 (90.9%) were men. Three patients (27.3%) were symptomatic, and no ruptures were observed. Elective surgery was performed in 10 patients (90.9%). The primary etiologies were atherosclerosis (81.8%) and Kawasaki disease (18.2%). Multiple aneurysms were present in 4 cases (36.4%). Off-pump coronary artery bypass grafting (CABG) was performed in 10 patients (90.9%), with concomitant aortic valve replacement in one case. The mean operative time was 325 ± 78.2 minutes, and the mean number of bypasses was 3.1 ± 1.5. Aneurysm resection was performed in 3 patients (27.3%). Early postoperative imaging confirmed graft patency in all cases. There were no 30-day mortalities. The 5-year MACCE-free survival and overall survival rates were 80.8% and 87.5%, respectively. No late aneurysmal ruptures occurred.
Conclusion: Surgical treatment of CAA in this cohort was safe and associated with favorable long-term outcomes. Tailoring surgical strategies based on aneurysm size and location may help optimize prognosis.
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