Objectives The determination of the risk factors of neurological complications for simultaneous carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG) and the ways to reduce them.
Methods 7568 patients (mean age 61.3 ± 7.3, men prevailed) underwent CABG during the period 2003 – 2010. Simultaneous surgical procedures (SSP) - CEA + CABG were performed in 229 (3.0%) cases. In all patients CEA was performed as the first stage, CABG as the next one. The present research consists of 2 parts: retrospective analysis of 123 SSP and prospective evaluation of 106 SSP.
Results 229 SSP (CEA + CABG) were performed using cardiopulmonary bypass (CB) and warm blood cardioplegia. Mean duration of surgery was 287 ± 41min, CB – 96 ± 27 min, anoxia – 61 ± 27 min, carotid cross-clamping – 13.3 ± 3.5 min. Performing SSP at first we registered a considerable rate of neurological complications in patients with bilateral carotid disease: ischemic stroke – 11.2%, mortality rate – 5.8%. The retrospective multivariate logit regression analysis of the results of 123 SSP detected the following risk factors for ischemic stroke: contralateral stenosis of internal carotid artery (ICA) > 75% (p = 0.049), system hypothermia (rectal temperature) > 29 °C (p = 0.031). Consequently, since 2010 we changed the surgical approach in patients with combined coronary and carotid disease. Thus, patients with contralateral stenosis of ICA > 75% undergo surgery in system hypothermia with < 29 °C. In the prospective part of the analysis of 106 SSP 2 groups were reviewed: group 1 – 57 (53.7%) patients with bilateral stenosis of ICA > 75%; group 2 – 49 (46.3%) patients with unilateral stenosis of ICA > 75%.In group 1 stroke was registered in 1.75%, mortality rate was 1.75%. In group 2 stroke was observed in 2%, mortality rate was 2%.
Conclusions The risk factors for ischemic stroke for SSP (CEA + CABG) are contralateral stenosis of ICA > 75%, system hypothermia (rectal temperature) > 29 °C. The use of hypothermic perfusion on the CEA phase of SSP in patients with bilateral stenosis of ICA > 75% effectively reduces neurological complications (9 times less), stroke rate (6.5 times less (p = 0.047)), mortality rate (3 times less (p = 0.3)).
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