P138. Left Main Coronary Artery Aneurysms: Characteristics and Clinical Outcomes of a Rare Surgical Cohort
Presented During: Adult Cardiac Poster Session II
Cleveland Clinic
Cleveland, OH
United States - Contact Me
Aryan Pasricha is a research student at the Cleveland Clinic Heart, Vascular & Thoracic Institute, where he works under the mentorship of Dr. Eric Roselli on clinical outcomes and cardiovascular research. Originally from Toronto, Canada, he earned his undergraduate degree from Wake Forest University, where he majored in Health and Exercise Science. His academic interests center on aortic disease, translational research, and outcomes-based clinical investigation. Aryan is applying to medical school in hopes of beginning his medical training in the coming years.
Monday, May 4, 2026: 9:00 AM - 4:00 PM
McCormick Place Lakeside Center
Room: Exhibit Hall, Poster Area
Description
Objective: Left main coronary artery (LMCA) aneurysms are the rarest form of coronary artery aneurysms. Due to their rarity, the optimal surgical strategy remains undefined. We sought to evaluate the clinical characteristics, operative management, and outcomes of patients with LMCA aneurysms.
Methods: Between 01/2006-01/2025, 11 patients underwent surgical treatment for LMCA aneurysms at our institution. Clinical presentation, imaging, operative findings, aneurysm morphology, and postoperative outcomes were analyzed. The primary endpoint was all-cause mortality at 30, 90, and 180 days, and at 1 and 5 years.
Results: Mean age at surgery was 62±10 years; 4 patients (36%) presented with angina, and 2 had >50% affected vessel obstruction. Etiologies included atherosclerotic (n=4,36%), infective (n=2,18%), fistula-related (n=1,9.1%) and idiopathic (n=4,36%). LMCA diameter ranged from 6.2 mm to 59 mm with a median of 15 mm. Most aneurysms were distal (n=5, 46%), followed by proximal (n = 3, 27%), of which 2 involved the ostium. Two were diffuse (18%), and one was in the mid LMCA (9.1%). Fusiform morphology predominated (n=7, 64%), followed by saccular (n=3, 27%) and ectatic (n=1, 9.1%). Intramural thrombus was present in 2 patients (18%) and calcification in 4 (36%). Surgical approaches included aneurysm excision-ligation with CABG (n=6, 55%), CABG alone (n=3, 27%), plication alone (n=1, 9.1%), and fistula-ligation alone (n=1, 9.1%). The fistula-ligation only was feasible due to the small diameter of the LMCA aneurysm without significant atherosclerosis requiring CABG. In-hospital mortality occurred in 1 patient (9.1%) who underwent redo sternotomy and debridement for an infected coronary artery pseudoaneurysm. Following excision-ligation with CABG of the LMCA, patient left the operating room on mechanical circulatory support. His condition continued to deteriorate, progressing to uncontrollable disseminated intravascular coagulation and multi-organ failure. Survival at 30, 90, and 180 days was 91%, 82%, and 73%, respectively; at 1 and 5 years it was 73% and 64%. No deaths beyond 30 days were procedural related.
Conclusion: LMCA aneurysms remain rare and are often identified incidentally during evaluation for other cardiac conditions. Distal fusiform aneurysms were the most common presentation. Ligation with CABG was the predominant operative strategy and was associated with good perioperative outcomes and low in-hospital mortality.
Authors
Aryan Pasricha (1), Philip Leib (1), Mahmoud Alshneikat (1), Tarek Nukta (1), Jonathan Putnam (2), Eugene Blackstone (1), Eric Roselli (1), Faisal Bakaeen (1)
Institutions
(1) Cleveland Clinic, Cleveland, OH, (2) Case Western Reserve University School of Medicine, Cleveland, OH
Methods: Between 01/2006-01/2025, 11 patients underwent surgical treatment for LMCA aneurysms at our institution. Clinical presentation, imaging, operative findings, aneurysm morphology, and postoperative outcomes were analyzed. The primary endpoint was all-cause mortality at 30, 90, and 180 days, and at 1 and 5 years.
Results: Mean age at surgery was 62±10 years; 4 patients (36%) presented with angina, and 2 had >50% affected vessel obstruction. Etiologies included atherosclerotic (n=4,36%), infective (n=2,18%), fistula-related (n=1,9.1%) and idiopathic (n=4,36%). LMCA diameter ranged from 6.2 mm to 59 mm with a median of 15 mm. Most aneurysms were distal (n=5, 46%), followed by proximal (n = 3, 27%), of which 2 involved the ostium. Two were diffuse (18%), and one was in the mid LMCA (9.1%). Fusiform morphology predominated (n=7, 64%), followed by saccular (n=3, 27%) and ectatic (n=1, 9.1%). Intramural thrombus was present in 2 patients (18%) and calcification in 4 (36%). Surgical approaches included aneurysm excision-ligation with CABG (n=6, 55%), CABG alone (n=3, 27%), plication alone (n=1, 9.1%), and fistula-ligation alone (n=1, 9.1%). The fistula-ligation only was feasible due to the small diameter of the LMCA aneurysm without significant atherosclerosis requiring CABG. In-hospital mortality occurred in 1 patient (9.1%) who underwent redo sternotomy and debridement for an infected coronary artery pseudoaneurysm. Following excision-ligation with CABG of the LMCA, patient left the operating room on mechanical circulatory support. His condition continued to deteriorate, progressing to uncontrollable disseminated intravascular coagulation and multi-organ failure. Survival at 30, 90, and 180 days was 91%, 82%, and 73%, respectively; at 1 and 5 years it was 73% and 64%. No deaths beyond 30 days were procedural related.
Conclusion: LMCA aneurysms remain rare and are often identified incidentally during evaluation for other cardiac conditions. Distal fusiform aneurysms were the most common presentation. Ligation with CABG was the predominant operative strategy and was associated with good perioperative outcomes and low in-hospital mortality.
Authors
Aryan Pasricha (1), Philip Leib (1), Mahmoud Alshneikat (1), Tarek Nukta (1), Jonathan Putnam (2), Eugene Blackstone (1), Eric Roselli (1), Faisal Bakaeen (1)
Institutions
(1) Cleveland Clinic, Cleveland, OH, (2) Case Western Reserve University School of Medicine, Cleveland, OH
Presentation Duration
There is no formal presentation for posters. Your poster will be on display on your assigned day from 9:00AM - 4:00PM
View Submission
ADULT CARDIAC
Coronary Artery Disease