The Journal of thoracic and cardiovascular surgery · 2026
Coronary Artery Aneurysms: Evolving Trends in Surgical Management.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Alshneikat Mahmoud, Alaraj Rami, Awad Ahmed K, Ramsingh Richard, Ehrlinger John, Houghtaling Penny L, Koprivanac Marijan J, Kapadia Samir, Tong Michael Z, Soltesz Edward G, Smedira Nicholas G, Roselli Eric E, Wierup Per, Gillinov A Marc, Svensson Lars G, Blackstone Eugene H, Pettersson Gösta B, Unai Shinya, Bakaeen Faisal G
Аннотация
OBJECTIVES: To evaluate temporal trends and evolution of surgical techniques for coronary artery aneurysms.
METHODS: From 1/2006 to 1/2025, 146 patients (age 63±13 years; 37[25%] female) with 172 coronary aneurysms underwent coronary surgery at Cleveland Clinic. Indications, operative trends, and outcomes were analyzed. Patients fell into 2 groups: the addressed(N=85), when the aneurysm was a direct or indirect indication for surgery, or the unaddressed(N=61) in which it was not.
RESULTS: Operative indications in the addressed group were size (58[68%]), aneurysm-related coronary ischemia (55[65%]), shunting (27[32%]), concomitant coronary artery disease (22[26%]), and infection (4[4.7%]). In the unaddressed group, coronary ischemia due to coronary artery disease was the sole indication. Patients in the addressed group underwent ≥1 of the following: coronary artery bypass grafting (CABG) (60[71%]), (14[16%] CABG alone), excision/ligation (34[40%]), fistula ligation (31[36%]), in-situ graft-based reconstruction (19[22%]), and direct repair (9[11%]). More comprehensive aneurysm-directed repairs, including graft-based reconstruction, increased over time. All unaddressed patients underwent CABG alone. Operative mortality was 2.4% and 3.4% for the addressed and unaddressed groups, respectively. Five- and 10-year survival was 80% and 63% in the addressed group versus 63% and 48% in the unaddressed group. Survival in both groups was similar to our institutional age- and sex-matched CABG cohorts (addressed log-rank P=.67; unaddressed log-rank P=.45).
CONCLUSIONS: Surgical management of coronary artery aneurysms has evolved toward more complex aneurysm-directed reconstructions. When indicated by aneurysm size, ischemia, shunting, infection, or symptoms, surgical repair can be performed without added risk, with long-term survival comparable to the general CABG population.
METHODS: From 1/2006 to 1/2025, 146 patients (age 63±13 years; 37[25%] female) with 172 coronary aneurysms underwent coronary surgery at Cleveland Clinic. Indications, operative trends, and outcomes were analyzed. Patients fell into 2 groups: the addressed(N=85), when the aneurysm was a direct or indirect indication for surgery, or the unaddressed(N=61) in which it was not.
RESULTS: Operative indications in the addressed group were size (58[68%]), aneurysm-related coronary ischemia (55[65%]), shunting (27[32%]), concomitant coronary artery disease (22[26%]), and infection (4[4.7%]). In the unaddressed group, coronary ischemia due to coronary artery disease was the sole indication. Patients in the addressed group underwent ≥1 of the following: coronary artery bypass grafting (CABG) (60[71%]), (14[16%] CABG alone), excision/ligation (34[40%]), fistula ligation (31[36%]), in-situ graft-based reconstruction (19[22%]), and direct repair (9[11%]). More comprehensive aneurysm-directed repairs, including graft-based reconstruction, increased over time. All unaddressed patients underwent CABG alone. Operative mortality was 2.4% and 3.4% for the addressed and unaddressed groups, respectively. Five- and 10-year survival was 80% and 63% in the addressed group versus 63% and 48% in the unaddressed group. Survival in both groups was similar to our institutional age- and sex-matched CABG cohorts (addressed log-rank P=.67; unaddressed log-rank P=.45).
CONCLUSIONS: Surgical management of coronary artery aneurysms has evolved toward more complex aneurysm-directed reconstructions. When indicated by aneurysm size, ischemia, shunting, infection, or symptoms, surgical repair can be performed without added risk, with long-term survival comparable to the general CABG population.