Temporal trends and surgical outcomes for coronary artery aneurysms (CAAs) in 146 patients (172 aneurysms) treated at Cleveland Clinic from January 2006 to January 2025, comparing those whose aneurysm was directly addressed surgically (n=85) versus those where it was not (n=61).
Operative mortality was low (2.4% addressed, 3.4% unaddressed); 5- and 10-year survival was 80%/63% in the addressed group and 63%/48% in the unaddressed group — both statistically similar to age- and sex-matched institutional CABG cohorts (log-rank P=.67 and P=.45, respectively). Graft-based reconstruction and other complex aneurysm-directed repairs increased over time.
Single-center retrospective study spanning nearly two decades, limiting generalizability and subject to selection and referral bias. No randomization; indication for surgical addressing of the aneurysm was at surgeon discretion. The unaddressed group had lower 5- and 10-year survival than the addressed group, which may reflect differences in baseline risk rather than treatment effect.
Surgical repair of coronary artery aneurysms — when indicated by size, ischemia, shunting, infection, or symptoms — can be performed with low operative mortality and long-term survival comparable to standard CABG patients. Clinicians should consider aneurysm-directed repair (including graft-based reconstruction) for appropriately selected patients, as the field is trending toward more complex, comprehensive techniques.
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