| Cardiac Surgery for Takayasu's
Disease |
(Department of Cardiovascular Surgery, Toyama Prefectural
Central Hospital, Toyama, Japan)
| Yukihisa Isomatsu |
Hiroyuki Tsukui |
Shuichi Hoshino |
| Yasushi Nishiya |
|
|
|
Eight patients with Takayasu's disease
underwent cardiac surgery between 1983 and 1998. All were women
and the age at the time of operation ranged from 42 to 68 years
(mean, 53.8 years). They were divided into two groups according
to the coronary artery involvement: group A (n＝3) had aortic
regurgitation with an intact coronary artery and underwent aortic
valve replacement (AVR); group B (n＝5) had coronary artery lesion
and underwent coronary artery bypass grafting (CABG) concomitant
with or without AVR. All AVR procedures were performed using
mechanical valves. At the CABG operation, saphenous veins alone
were used in three cases and the left internal thoracic artery
and saphenous veins in two. The actuarial survival rate was 65.6%
at 5 years and 32.8% at 10 years. There were no early or late
deaths in group A. On the contrary, there were one hospital death
and two late deaths in group B. We discussed the timing of surgical
intervention, the kind of prosthetic valve, the material of bypass
graft and the procedure of CABG, the postoperative steroid use,
and the surgical prognosis. The optimal timing of surgery for
cardiac involvement is, needless to say, the inactive phase of
inflammation. However, there are some patients who require operations
during the active phase because of medically intractable or worsening
symptoms. There is a consensus regarding the kind of prosthesis,
and the mechanical valve is usually employed. There are still
controversies regarding the material of grafts. We do not know
the late results of saphenous vein graft in Takayasu's disease
although saphenous vein is thought to be the choice of graft
and several CABG procedures are advocated. The left internal
thoracic artery might be used as a graft if the patient with
Takayasu's disease had no subclavian artery lesions and was stable
with an antiinflammatory regimen. We recommend the postoperative
steroid therapy to control inflammation and also describe the
antiinflammatory regimen after cardiac surgery in Takayasu's
disease. It is essential that we have to meticulously follow
up the patients with Takayasu's disease who underwent cardiac
operations, paying especial attention to the side effects of
steroid as well as the progression of inflammation.
Jpn. J. Cardiovasc. Surg. 30: 15-18 (2001) |
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