Irqsusi Marc, Vannucchi Alessandro, Beckers Julius, Kasseckert Stefan, Waldhans Stefan, Vogt Sebastian, Moosdorf Rainer G H
Heart Surgery, University Hospital Giessen and Marburg GmbH, Philipps University, Marburg, Germany.
WKK Perfusionstechnik GmbH, Neuss, Germany.
Thorac Cardiovasc Surg. 2018 Apr;66(3):261-265. doi: 10.1055/s-0037-1601425. Epub 2017 Apr 5.
The purpose of this single-center, retrospective study was to review the early outcome with defined endpoints of myocardial infarction, brain injury, and death after coronary bypass grafting and simultaneous carotid endarterectomy with or without combined valve replacement.
During the preoperative investigation 52 (44 males, 8 females) patients were examined by cardiac catheterization within the scope of their coronary status. In addition, all patients underwent echocardiography, CT angiography of the supra-aortic vessels, and full description of their neurologic status. Included were all patients with the need of coronary revascularization, valve disease, and either symptomatic or asymptomatic carotid artery stenosis with a maximal narrowing of >70%.
There was one (2%) patient with a perioperative stroke and paresis of the upper limb. One (2%) patient experienced PRIND (2%). Eighteen (35%) patients suffered that fully recovered in all patients. One (2%) patient incurred a perioperative myocardial infarction that could be cured by percutaneous coronary stent implantation. Overall mortality was 4%.
Simultaneous coronary bypass grafting as a single procedure or in combination with valve replacement and endarterectomy of severe carotid lesions with or without patients' history of previous stroke can be performed with a calculated low surgical risk. The complication rate for neurologic and myocardial events is low compared with the hazard of a single surgical repair. The in-hospital mortality is not significantly different to isolated procedures. The concomitant appearance of coronary stenosis and carotid artery disease is reasonable due to the nature of arteriosclerosis. In our opinion these patients benefit from a combined surgical approach.
本单中心回顾性研究的目的是回顾在冠状动脉搭桥术及同期颈动脉内膜切除术（无论是否联合瓣膜置换）后，以心肌梗死、脑损伤和死亡为明确终点的早期结局。
在术前检查期间，52例患者（44例男性，8例女性）在冠状动脉状况评估范围内接受了心导管检查。此外，所有患者均接受了超声心动图、主动脉弓上血管CT血管造影检查，并对其神经状态进行了全面描述。纳入的患者均为需要进行冠状动脉血运重建、患有瓣膜疾病，以及存在有症状或无症状的颈动脉狭窄且最大狭窄程度>70%的患者。
有1例（2%）患者发生围手术期卒中及上肢麻痹。1例（2%）患者发生术后认知功能障碍（PRIND）。18例（35%）患者出现了……所有患者均完全康复。1例（2%）患者发生围手术期心肌梗死，可通过经皮冠状动脉支架植入术治愈。总体死亡率为4%。
同期冠状动脉搭桥术作为单一手术或与瓣膜置换及严重颈动脉病变内膜切除术联合进行（无论患者既往是否有卒中病史），手术风险经计算较低。与单一手术修复的风险相比，神经和心肌事件的并发症发生率较低。住院死亡率与单独手术无显著差异。由于动脉粥样硬化的性质，冠状动脉狭窄和颈动脉疾病同时出现是合理的。我们认为这些患者从联合手术方法中获益。
