DOI: https://doi.org/10.25305/unj.178622

The results of simultaneous revascularization operations of the carotid and coronary territory in patients with multifocal atherosclerosis

Sergiy P. Grygoruk, Svitlana O. Dudukina

Abstract


Objective: To determine the effectiveness of simultaneous surgical interventions for revascularization of the carotid and coronary basins.

Materials and methods: The effectiveness of the surgical intervention was assessed in 34 patients (31 male patients, 3 female patients, average age 61.8 ± 1.52 years) who underwent simultaneous carotid endarterectomy and coronary artery bypass grafting. The indications for surgical treatment for carotid arteries disease were determined by a neurosurgeon, and for coronary artery bypass grafting — by a cardiac surgeon.

Results: Postoperative complications were observed in 55.9 % of patients. In 3 (8.8 %) patients, an acute ischemic stroke with a neurological deficit developed on the first day after the operation. One patient (2.9 %) presented with both an acute myocardial infarction in the postoperative period and an acute heart failure. Perioperative rhythm disturbances in the form of atrial fibrillation were observed in 6 (17.6 %) cases. Postoperative mortality was 2.9 %. During the first year after surgery, an improvement in the quality of life was observed in 31 (93.9 %) patients in the form of an improvement in the functional state of angina pectoris, a reduction of the heart failure symptoms, or a complete regression of cardiac symptoms. Two (6.06 %) patients needed for repeated myocardial revascularization. Within 3 years of follow-up, no patient developed an ischemic stroke. The patients who developed cerebral event immediately after surgery had a stable neurological status. The commutative survival rate (percentage of patients who survived within the indicated period) of patients for 1 year of observation was 100 %, for 3 years — 96 %. A significant drop in survival function was observed in the fourth year of observation up to 75 % due to the development of repeated acute myocardial infarction.

Conclusions: The simultaneous revascularization of the carotid and coronary territory in the form of a carotid endarterectomy and aortocoronary bypass surgery is an effective modern method for preventing the development of stroke and acute myocardial infarction, improving the neurological and general somatic status, quality of life of patients with combined atherosclerotic lesions of the carotid and coronary arteries.


Keywords


carotid endarterectomy; coronary artery bypass grafting; simultaneous surgery

References


1. Cheng H, Udesh R, Mehta A, Thirumala PD. Perioperative strokes after coronary artery bypass grafting with staged carotid endarterectomy: A nationwide perspective. J Clin Anesth. 2017 Jun;39:25-30. [CrossRef] [PubMed]

2. Pinto Sousa P, Teixeira G, Gonçalves J, Veiga C, Sá Pinto P, Brandão P, Canedo A, Vouga L, Almeida R. Carotid Stenosis in Cardiac Surgery Patients. Rev Port Cir Cardiotorac Vasc. 2017 Jul-Dec;24(3-4):126. [PubMed]

3. Wang LJ, Ergul EA, Mohebali J, Goodney PP, Patel VI, Conrad MF, Eagleton MJ, Clouse WD. The effect of combining coronary bypass with carotid endarterectomy in patients with unrevascularized severe coronary disease. J Vasc Surg. 2019 Sep;70(3):815-823. [CrossRef] [PubMed]

4. Weimar C, Bilbilis K, Rekowski J, Holst T, Beyersdorf F, Breuer M, Dahm M, Diegeler A, Kowalski A, Martens S, Mohr FW, Ondrášek J, Reiter B, Roth P, Seipelt R, Siggelkow M, Steinhoff G, Moritz A, Wilhelmi M, Wimmer-Greinecker G, Diener HC, Jakob H, Ose C, Scherag A, Knipp SC; CABACS Trial Investigators. Safety of Simultaneous Coronary Artery Bypass Grafting and Carotid Endarterectomy Versus Isolated Coronary Artery Bypass Grafting: A Randomized Clinical Trial. Stroke. 2017 Oct;48(10):2769-2775. [CrossRef] [PubMed] [PubMed Central]

5. On approval and implementation of medical and technological documents on standardization of medical care for stable coronary heart disease. Order of the Ministry of Health of Ukraine # 152 of 03/02/2016.

6. On approval and implementation of medical and technological documents on standardization of medical care for ischemic stroke. Order of the Ministry of Health of Ukraine # 602 of 03/08/2012.


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Copyright (c) 2019 Sergiy P. Grygoruk, Svitlana O. Dudukina

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