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

Full text:  

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.

References

1. Бокерия Л.А., Гудкова Р.Г. Болезни системы крово- обращения и сердечно-сосудистая хирургия в Рос- сийской Федерации. Состояние и проблемы. Ана- литический вестник. 2015; 44 (597): 9–18. 2. Бокерия Л.А., Пирцхалаишвили З.К., Сигаев И.Ю., Мерзляков В.Ю., Алшибая М.М., Бокерия О.Л. и др. Хирургическая тактика при сочетанном пора- жении коронарных и сонных артерий. Анналы хи- рургии. 2011; 2: 59–63. 3. Ярбеков Р.Р. Современные подходы к хирургичес- кому лечению больных ИБС в сочетании с атеро- склеротическим поражением сонных артерий. Бюллетень НЦССХ им. А.Н. Бакулева РАМН. 2009; 10 (2): 41–8. 4. Hines G.L., Scott W.C., Schubach S.L., Kofsky E., Wehbe U., Cabasino E. Prophylactic carotid endarterectomy in patients with high-grade carotid stenosis undergoing coronary bypass: does it decrease the incidence of perioperative stroke. Ann. Vasc. Surg. 1999; 12: 23–7. 5. Evagelopoulos N., Trenz M.T., Beckman A., Krian A. Simultaneous carotid endarterectomy and coronary bypass grafting in 313 patients. Cardiovasc. Surg. 2000; 8: 31–40. 6. Huh J., Wall M.J., Soltero E.R. Treatment of combined coronary and carotid artery disease. Curr. Opin. Cardiol. 2003; 18: 447–53. 7. Ozatik M.A., Gol M.K., Fansa I., Uncu H., Kucuker S.A., Kucukaksu S. et al. Risk factors for stroke following coronary artery bypass operations. J. Card. Surg. 2005; 20: 52–7. 8. Schwartz L.B., Bridgman A.H., Kieffer R.W., Wilcox R.A., McCann R.L., Tawil M.P. et al. Asymptomatic carotid artery stenosis and stroke in patients undergoing cardiopulmonary bypass. J. Vasc. Surg. 1995; 21: 146–53. 9. D'Ancona G., Saez de Ibarra J., Baillot R., Mathieu P., Doyle D., Metras J. et al. Determinants of stroke after coronary artery bypass grafting. Eur. J. Cardiothorac. Surg. 2003; 24: 552–6. 10. Likosky D.S., Caplan L.R., Weintraub R.M., Hartman G.S., Malenka D.J., Ross C.S. et al. Intraoperative and postoperative variables associated with strokes following cardiac surgery. Heart Surg. Forum. 2004; 7: E271–6. 11. Naylor A.R., Mehta Z., Rothwell P.M., Bell P.R. Carotid artery disease and stroke during coronary artery bypass: a critical review of the literature. Eur. J. Vasc. Endovasc. Surg. 2002; 23: 283–94. 12. Бокерия Л.А., Сигаев И.Ю., Дарвиш Н.А., Мака- ренко В.Н., Шумилина М.В. Профилактика невро- логических осложнений в сердечно-сосудистой хи- рургии. Журнал неврологии им. Б.М. Маньковского. 2013; 2: 80–4. 13. Бокерия Л.А., Керен М.А., Енокян Л.Г., Сига- ев И.Ю., Мерзляков В.Ю., Вольгушев В.Е., Ярах- медов Т.Ф. Результаты аортокоронарного шун- тирования с использованием искусственного крвоообращения и на работающем сердце у боль- ных ишемической болезнью сердца пожилого и старческого возраста. Грудная и сердечно-сосудис- тая хирургия. 2011; 6: 9–14. 14. Mishra Y., Wasir H., Kohli V., Meharwal Z.S, Malhotra R., Mehta Y. et al. Concomitant carotid endarterectomy and coronary bypass surgery: outcome of onpump and off-pump techniques. Ann. Thorac. Surg. 2004; 78: 2037–43. 15. Федоров С.А., Большедворов Р.В., Лихванцев В.В. Причины ранних расстройств психики больного после операций, выполненных в условиях общей анестезии. Вестник интенсивной терапии. 2007; 4: 17–25. 16. Bucerius J., Gummert J.F., Borger M.A., Walther T., Doll N., Falk V. et al. Predictors of delirium after cardiac surgery delirium: effect of beating-heart (offpump) surgery. J. Thorac. Cardiovasc. Surg. 2004; 127: 57–64. 17. McKhann G.M., Grega M.A., Borowicz L.M., Bechamps M., Selnes O.A., Baumgartner W.A., Royall R.M. Encephalopathy and stroke after coronary artery bypass grafting: incidence, consequences, and prediction. Arch. Neurol. 2002; 59: 1422–8. 18. Rudolph J.L., Babikian V.L., Birjiniuk V., Crittenden M.D., Treanor P.R., Pochay V.E. et al. Atherosclerosis is associated with delirium after coronary artery bypass graft surgery. J. Am. Geriatr. Soc. 2005; 53: 462–6. 19. Santos F.S., Velasco I.T., Fraguas R. Risk factors for delirium in the elderly after coronary artery bypass graft surgery. Int. Psychogeriatr. 2004; 16: 175–93. 20. Gootjes E.C., Wijdicks E.F., McClelland R.L. Postoperative stupor and coma. Mayo Clin. Proc. 2005; 80: 350–35.

 If you found mistakes, select text and press Alt+A