Efficacy Of Simultaneous Coronary Artery Bypass Grafting And Carotid Endarterectomy

ObjectiveTo sum up the clinical effects of combined coronary artery bypass grafting(CABG)and carotid endarterectomy(CEA)on patients with carotid arteriostenosis and coronary heart disease,and discussing the operation experience and methods of preventing and treating complications.MethodsThe clinical data were retrospectively analyzed in 30 patients who underwent combined surgery of CEA and CABG between July 2008 and July 2017 in Qilu Hospital of Shandong University and the patients were followed up after the surgery.We analysed the clinical materials,including the sex,age,smoking history,past medical history,disease,the state of Carotid arteriostenosis and Coronary heart disease,operation,postoperative complications and prognosis.We discussed the effect of simultaneous CABG and CEA,the operative method,the possible causes of postoperative complications and the corresponding prevention and treatment measures,so as to improve the operation effect of CABG and CEA during the same period.ResultsA total of 30 patients with CABG/CEA were collected,including 26 males and 4 females and the average age is 63.5±6.2 years.There were 4 cases with left main coronary artery disease,25 cases with three-vessel coronary artery disease,4 cases with old myocardial infarction,16 cases with cerebral ischemia or old cerebral infarction,12 cases with hypertension,5 cases with diabetes,5 cases with mitral valve disease,2 cases with aortic valve disease,1 case with mitral valve and aortic valve disease,20 cases with severe unilateral carotid stenosis and 10 cases with severe stenosis of bilateral carotid artery.All 30 patients underwent severe unilateral CEA before CABG.None of the patients had cerebral complications and myocardial infarction during the perioperative period.A patient who underwent CABG+AVR+MVR+CEA died of renal failure after operation,2 patients had neck hematoma and 3 patients had hoarseness after operation.27 cases were followed up,2 cases were lost,and the follow-up rate was 93%.Angina pectoris occurred in 1 case 3 years after operation.Coronary angiography showed that the coronary artery stenosis was more serious than before,but there was no obvious stenosis in the anastomotic vessels.1 case of CABG+MVR+CEA patients had tricuspid regurgitation 2 years after operation,and the heart function was grade ?(NYHA grade).The rest of the patients' cardiac function was grade ?-?,which was obviously improved compared with the preoperative.All patients had no cerebral infarction and acute myocardial infarction after operation.The symptoms of cerebral ischemia were better than before.21 cases underwent re-examination of carotid artery ultrasound and 14 cases of carotid CTA during the mid-term follow-up.The blood flow of the carotid artery was smooth in the operational side,and the contralateral carotid stenosis was aggravated in 8 cases.Statistical analysis showed that the internal diameter and peak velocity of carotid artery were significantly different from those before surgery(P<0.05).ConclusionSimultaneous CABG and CEA are safe and effective for patients with coronary heart disease and carotid arteriostenosis.