The mortality rate for elective infrarenal aortic surgery is on the order of 5%-7%. Most deaths are related to coronary heart disease (CAD). Significant coronary heart disease is present in some 60% of patients who need elective aortic operations. Risk-stratification scales are not particularly helpful in finding CAD. It is generally assumed that since the more straightforward cases are managed by endoprosthesis, the mortality rate related to open repair may be on the rise. We report 218 consecutive elective infrarenal aortic operations performed at the Swiss Cardiovascular Center (University Hospital, Berne) between 1998 and 2001. There were 36 (17%) females and 182 (83%) males, mean age 66.7 years (range 42-86 years). Of the patients, 87 (40%) were older than 70, 35 (16%) older than 75 years of age. A prior myocardial infarction was diagnosed in 42 (19%), 141 (65%) were hypertensive, 20 (9%) had diabetes mellitus (IDDM), 24 (11%) renal insufficiency (creatinin >13 mg/ dL) and 79 (36%) chronic obstructive pulmonary disease (COPD). The initial screening was done by an in-house internist. As a result, 179 patients (82%) underwent cardiological evaluation, which in turn led to 71 (33%) stress echocardiographies, and subsequently 47 (22%) coronary angiographies. This in turn led to coronary revascularization in 24 (11%). Five carotid endarterectomies (2.3%) were performed prior to planned aortic surgery. There was no mortality related to these operations. Aneurysm repair was performed in 165 (76%) patients, surgery for atherosclerotic lesions in 53 (24%). In-hospital mortality was 1 (0.5%). There was no further 30-day mortality. We conclude that the results of open infrarenal aortic surgery can be improved by active screening by an in-house internist and treatment of underlying vascular and lung disease. This should be reflected in reimbursement policies.

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