Concomitant coronary and cerebral revascularization under cardiopulmonary bypass.

The question as to whether a staged or a combined surgical approach is safer in the management of patients with coexistent coronary and extracranial cerebrovascular disease has been widely investigated and debated. Advances in myocardial protection techniques have reduced cardiac morbidity and mortality and have rendered a combined approach as safe as a staged approach, if not safer. There have been no similar advances in cerebral protection, particularly for high-risk patients with bilateral disease. In this series, 32 consecutive patients with coexistent advanced coronary and extracranial vascular disease underwent cerebral and coronary revascularization that used the combined approach. Cerebral revascularization was performed under hypothermic cardiopulmonary bypass on 30 of these patients. There was no operative mortality, no hematoma formation, and no reoperation. Blood loss, length of hospital stay, and total cost were similar to those for isolated coronary bypass procedures.