Fillinger M F, Rosenberg J M, Semel L, Levy I E, Byrne J, Marvasti M A, Zaman S N
Department of Surgery, St Joseph's Hospital Health Center, Syracuse, New York.
Cardiovasc Surg. 1993 Feb;1(1):7-12.
A study examining combined carotid endarterectomy and coronary artery bypass (CAB) outside the metropolitan or university hospital setting was performed. Over a 5-year period, 52 patients underwent carotid endarterectomy and CAB under a single anesthetic. Twenty-two patients (42%) had unstable angina and 23 (44%) had previous neurologic symptoms. There were two postoperative strokes (4%), one ipsilateral and one contralateral to the endarterectomy site. No ipsilateral neurologic events occurred after discharge (mean follow-up 25 months). There were four deaths (8%), all of which were cardiac related. Three of the four deaths were in patients with a recent history of congestive heart failure, a subgroup with a high mortality rate (three of seven; 43%). Over the same period, 2421 patients underwent CAB alone with stroke and mortality rates of 1.4 and 2.0% respectively, while 344 patients had carotid endarterectomy alone with stroke and mortality rates of 0.6 and 0.6% respectively. It is concluded that the combined procedure can be performed in a community setting with morbidity and mortality rates similar to those for major centers. Although stroke and mortality rates for the combined procedure were higher than those for the isolated operations, this group has a high incidence of cardiac symptoms, including unstable angina and congestive heart failure. Patients with recent congestive heart failure had the highest mortality rate of any subgroup and these patients should be carefully examined with regard to selection for the combined procedure.
一项针对在大都市或大学医院环境之外进行颈动脉内膜切除术和冠状动脉搭桥术（CAB）联合手术的研究展开。在5年期间，52例患者在单一麻醉下接受了颈动脉内膜切除术和CAB手术。22例患者（42%）患有不稳定型心绞痛，23例（44%）有既往神经症状。术后发生了2例中风（4%），1例在动脉内膜切除部位同侧，1例在对侧。出院后未发生同侧神经事件（平均随访25个月）。有4例死亡（8%），均与心脏相关。4例死亡中有3例是近期有充血性心力衰竭病史的患者，这是一个死亡率较高的亚组（7例中有3例；43%）。在同一时期，2421例患者单独接受CAB手术，中风和死亡率分别为1.4%和2.0%，而344例患者单独接受颈动脉内膜切除术，中风和死亡率分别为0.6%和0.6%。结论是，联合手术可在社区环境中进行，其发病率和死亡率与主要中心相似。虽然联合手术的中风和死亡率高于单独手术，但该组心脏症状的发生率较高，包括不稳定型心绞痛和充血性心力衰竭。近期有充血性心力衰竭的患者在所有亚组中死亡率最高，对于这些患者进行联合手术的选择应仔细评估。
