Haydar SUR, Sinan ARSAN, Tekin YILDIRIM, Serdar AKGÜN, Hakan KINIKOĞLU, Feyza BİLGİN

Eş zamanlı karotis endarterektomi ile miyokardiyal revaskülarizasyonun erken dönem sonuçları

Amaç: Cerrahi girişim gereken koroner arter hastalığına karotis arter darlığı eşlik ettiğinde, cerrahi tedavi seçenekleri konusunda tartışmalar devam etmektedir. Bu grup hastalarda uyguladığımız cerrahi yaklaşım, kardiyopulmoner bypass ve orta derecede hipotermide karotis endarterektomi ve miyokardiyal revaskülarizasyonu eş zamanlı yapmaktır. Bu yöntemle ilgili deneyimlerimizi ve erken dönem sonuçlarımızı bildiriyoruz. Materyal ve Metod: Merkezimizde, Mart 2001 - Ocak 2003 tarihleri arasında 37 hastaya eş zamanlı karotis endarterektomi ve miyokardiyal revaskülarizasyon uygulandı. Hastaların yaş ortalaması 69.1 + 8.8 yıl olup, 28 hasta 65 yaş ve daha üzerindeydi. Hastaların 30'u erkek, yedisi kadındı. Hastaların %45.9'u nörolojik olarak semptomatik ve %40.5'inde bilateral karotis arter stenozu vardı. Karotis endarterektomi için lünıen çapının %70 ve daha fazla daralması, endovasküler trombojenik morfoloji veya her ikisi endikasyon oluşturmaktaydı. Karotis endarterektomi kardiyopulmoner bypassda kalp çalışırken orta derecede hipotermi, hemodilüsyon ve sistemik heparinizasyon ile ilave serebral koruma sağlanarak yapıldı. Bulgular: Postoperatif erken dönemde iki hasta (%5.4) kaybedildi. Bunlardan birisi hemipleji ve düşük kalp debisini takiben multiorgan yetersizliğinden, diğeri hemipleji ve sonrasında gelişen akciğer komplikasyonlanndan kaybedildi. Perioperatif nörolojik komplikasyon dört hastada (%10.8) meydana geldi. İkisi (%5.4) kalıcı hale geldi ve bu hastalar erken dönemde kaybedildi. Diğer ikisi daha sonra düzeldi. Bir hastada (%2.7) perioperatif miyokard infarktüsü gözlendi. Yaşayan 35 hasta toplam 358 hasta ayı, ortalama 9.6 ay (4-16) izlendi. Bu sürede kardiyak ya da nörolojik bir olay olmadı. Sonuç: Eş zamanlı veya karotis endarterektomi ve miyokardiyal revaskülarizasyonun kabul edilebilir bir mortalite ve morbidite ile uygulanabileceğini düşünüyoruz.

Short-term results of simultaneous carotid endarterectomy and myocardial revascularization

Background: Surgical treatment of concomitant coronary and carotid artery disease is controversial. Our operative strategy is to perform simultaneous carotid endarterectomy and myocardial revascularization in conjunction with cardiopulmonary bypass with moderate hypothermia. We report our experience this procedure and its short-term results. Methods: From March 2001 to January 2003, 37 consecutive patients underwent simultaneous carotid endarterectomy and myocardial revascularization in our center. Mean age of the patients was 69.1 +8.8 years, and 28 patients were 65 years old or older. There were 30 men and seven women. Fourtyfive point nine percent of patients were neurologically symptomatic and 40.5% had bilateral carotid stenosis. The indication for carotid endarterectomy was lumen diameter reduction of more than 70%, thrombogenic endovascular morphology or both. Carotid endarterectomy was performed in conjunction with cardiopulmonary bypass on the beating heart with moderate hypothermia, hemodulition and systemic heparinization for additional cerebral protection. Results: Two (5.4%) patients died-in postoperative early period. One of these patients died due to multiorgan failure following stroke and low cardiac output, other by reason of complications of pulmonary following stroke. There were four perioperative neurologic complications. Two (5.4%) of these patients have developed permanent deficit and died in postoperative early period. Others have recovered completely. There was one (2.7%) perioperative myocardiyal infarction. Thirty-five patients were alive in during study and traced for a mean follow-up of 9.6 months; total follow-up time is 358 patient-months. There were no neurological or cardiac problem. Conclusions: We believe that simultaneous carotid endarterectomy and myocardial revascularization can be performed with acceptable mortality and morbidity.

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