Clinical Physiology of Circulation

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Determinations of the optimal surgical treatment simultaneous operationsperform of carotid endarterectomy and coronary artery bypass graftingin the aspect of reducing the incidence of neurological complications

Authors: I.Yu. Sigaev, I.F. Kudashev, M.A. Keren, A.V. Kazaryan, M.V. Starostin, B.D. Morchadze

Company:
Bakoulev National Scientific and Practical Center for Cardiovascular Surgery, Ministry of Health of the Russia, Rublevskoe shosse, 135, Moscow, 121552, Russian Federation

E-mail: Сведения доступны для зарегистрированных пользователей.

DOI: https://doi.org/10.24022/1814-6910-2017-14-1-31-38

UDC: 616.831-089:616.132.2-089:616.8-06

Link: Clinical Physiology of Blood Circulaiton. 2017; 14 (1): 31-38

Quote as: Sigaev I.Yu., Kudashev I.F., Keren M.A., Kazaryan A.V., Starostin M.V., Morchadze B.D. Determinations of the optimal surgical treatment simultaneous operations perform of carotid endarterectomy and coronary artery bypass grafting in the aspect of reducing the incidence of neurological complications. Klinicheskaya Fiziologiya Krovoobrashcheniya (Clinical Physiology of Circulation, Russian journal). 2017; 14 (1): 31–8 (in Russ.).

Received / Accepted:  30.12.2016/10.01.2017

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Abstract

Objective – optimization of surgical treatment in patients with multifocal atherosclerosis and coronary disease and carotid sent for simultaneous operations carotid endarterektomy and coronary artery bypass grafting.
Material and methods. The study included 139 patients with combined lesions of coronary and carotid artery. All patients in the period from 2008 to 2016 was done concomitant coronary bypass surgery and endarterekotomy of the internal carotid artery. Patients were divided into two groups: group 1 included 97 patients who underwent coronary artery bypass grafting with cardiopulmonary bypass (CPB) and endarterectomy, in group 2 included 42 patients who had coronary artery bypass surgery on a beating heart, and endarterectomy was performed. We analyzed both the incidence of the major lifethreatening complications, and the incidence of postoperative complications of hospital rest period.
Results. The hospital mortality in group 1 was 11.3%, in group 2 – 4.8% (p=0.34). Despite the observed increase in postoperative stroke after CPB group compared with the group that underwent surgery on a beating heart, this difference did not reach statistical significance (3.1% and 0% in the groups, respectively, p=0.55). Also, there was no evidence of a statistically significant difference in the incidence of perioperative myocardial infarction, pulmonary, renal, infectious complications and bleeding. However, in the group 1 (CPB), we observed an increase in the frequency of total number of neurological complications. Extended analysis of the frequency of neurological complications showed that their total increase is due, primarily, the increase in the number of postoperative encephalopathy in patients undergoing surgery with cardiopulmonary bypass – 13,4%, in comparison with the group after coronary artery bypass surgery on a beating heart – 0% (p=0.01).
Conclusion. In our study, conducting simultaneous endarterectomy and coronary artery bypass surgery on a beating heart, as compared with endarterectomy and coronary bypass grafting with cardiopulmonary bypass, accompanied by reduction in the incidence of prolonged ventilation, postoperative encephalopathy and, as a consequence, increase the postoperative hospital stay. However, none of the methods of performing coronary artery bypass grafting (or with artificial circulation, or on a beating heart) did not have advantages in relation to the development of life-threatening complications such as stroke, myocardial infarction and death.

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