Clinical Study For Carotid Artery Stenosis In Patients Undergoing Off-pump Coronary Artery Bypass Grafting

Objective: To study the risk factors and prognosis of off-pump coronary artery bypass grafting(OPCAB) patients with carotid artery stenosis(CAS),as well as the clinical diagnosis and treatment of artery stenosis.Methods: Retrospective analysis of the clinical data of 491 patients undergoing elective OPCAB treatment from June 2013 to June 2015. All patients in preoperative cervical vascular ultrasound, according to the results of preoperative cervical vascular ultrasound, divided into carotid artery stenosis(CAS)(unilateral or bilateral stenosis greater than or equal to 50%) and control group(stenosis < 50%), compared two groups of basic date, multivariate Logistic regression analysis of risk factors for carotid artery stenosis(CAS). Based on CAS patients with stenosis degree and the treatment, were divided into group A patients with carotid artery stent/CEA treatment, B group of CAS heavy above narrow no neck vascular surgery patients, CAS in patients with moderate group C, group D CAS stenosis < 50% namely NCAS group, the comparison between the four groups of compared with pure OPCAB in plasma usage, ventilator use time, ICU stay time, postoperative death, reoperation, again into the ICU, follow-up of stroke, follow-up deaths, suspended red blood cells, postoperative cumulative volume of induced flow, postoperative follow-up of 1 year, comparing the prognosis of two methods and occurrence of stroke. Compare two groups intraoperative and postoperative conditions, analysis on the risk factors of postoperative death.Results: A total of 491 patients underwent OPCAB treatment, including CAS group of 135 cases, 135 cases of the control group, two groups of age, smoking history, COPD, peripheral vascular disease, stroke history differences statistically significant(P < 0.05). Logistic regression analysis showed that : high age(OR = 1.06, 95% CI: 1.03 ~ 1.09, P < 0.01), smoking history(OR = 1.88, 95% CI: 1.21 ~ 2.92, P < 0.01), hypertension(OR = 2.02, 95% CI: 1.25 ~ 3.26, P < 0.01), COPD(OR = 4.10, 95% CI: 1.27 ~ 13.25, P < 0.05), stroke history(OR = 1.69, 95% CI: 1.04 ~ 2.74, P < 0.05) are risk factors of OPCAB with CAS. Carotid artery stent or CEA joint OPCAB compared with pure OPCAB in plasma usage, ventilator use time, ICU stay time, postoperative death, reoperation, again into the ICU, follow-up of stroke, follow-up deaths, use of suspended red blood cells difference was not statistically significant(P > 0.05), postoperative cumulative volume of induced flow differences was statistically significant(P < 0.05), combined surgery may increase postoperative bleeding and use of blood products, patients undergoing carotid stent or CEA joint OPCAB has higher security. CAS(OR = 4.99, 95% CI: 1.15 ~ 21.71, P < 0.05), the history of PCI therapy(OR = 10.10, 95% CI: 2.18 ~ 46.75, P < 0.01), the use of IABP(OR = 9.19, 95% CI: 1.59 ~ 52.96, P < 0.05), low body mass index(OR = 0.73, 95% CI: 0.57 ~ 0.95, P < 0.05) in OPCAB are risk factors for postoperative patients died.Conclusion: High age, smoking, hypertension, COPD, stroke are risk factors for patients with OPCAB combined with CAS, patients with CAS who underwent OPCAB were more risk of death after surgery. Staging carotid stent or CEA joint OPCAB has higher safety and will not increase the mortality rate of patients.