Fikri YAPICI, Fuat BİLGEN, Yavuz ENÇ, Azmi ÖZLER, Bayer ÇINAR, Mehmet R. GÜNEY, Onur GÜRER, Nihan YAPICI

Koroner ve karotis arter hastalığında kombine cerrahi yaklaşım ve sonuçları

Amaç: Karotis endarterektomi sonrası miyokard enfarktüsü ve miyokardiyal revaskülarizasyon sonrası serebrovasküler inme ciddi ve sık karşılaşılan komplikasyonlardır. Bu çalışmada koroner arter ve karotise yönelik kombine girişimlerin mortalite ve morbiditeleriyle, erken ve orta dönem sonuçlarının değerlendirilmesi amaçlanmıştır. Materyal ve Metod: Beş yıllık dönem içerisinde kombine koroner bypass ve karotis endarterektomi uygulanan 30 olgu, erken ve orta dönem sonuçlarıyla retrospektif olarak incelenerek risk faktörleri, mortalite ve olaysız yaşam oranları değerlendirilmiştir. Bulgular: Erken postoperatif dönemde 30 olgu içinde 1 olguda (%3.3) major strok, 3 olguda (%9.9) geçici nörolojik defisit görüldü. Erken dönemde ölüm görülmedi. Kombine cerrahide ortalama klemp süresi karotis için 22 ± 6.8 dakika, aort için 50 ± 14 dakika olarak gerçekleşti. Olgular 51 ± 4.5 saatlik yoğun bakım ve 7.4 ± 1.2 günlük ortalama servis süresi içinde taburcu edildi. Olguların %87'si klinik olarak izlenebildi. Toplam olarak 612 hasta ayı (ortalama 22.67 ± 17.21 ay) izlem süresi boyunca 2 olgu (%6.6) kardiyak nedenle, bir olgu (daha önce hemipleji geçiren) kalp dışı nedenle kaybedildi ve 1 olguda major serebrovasküler atak gelişti. İki olguda elektif olarak kontralateral karotis endarterektomi uygulandı. Sonuç: Kombine karotis endarterektomi ve aortokoroner bypass uygulaması, ciddi karotis lezyonu ve semptomatik koroner arter hastalığı olan olgularda kabul edilebilir mortalite ve morbidite ile uygulanabilecek bir tekniktir.

Combined surgery for coronary and carotid artery disease: Management and results

Background: Myocardial infarction has been described as a frequent complication of carotid endarterectomy. Likewise, stroke has been seen as a major complication following myocardial revascularization. In this study, we aimed to evaluate mortality - morbidity, and early - and midterm results of the patients who underwent combined surgery for coronary and carotid artery disease. Methods: A consecutive series of 30 patients with coexisting severe coronary and carotid artery disease were operated during the five year period. Standart combined surgical procedures were coronary bypass grafting and carotid endarterectomy in all of 30 patients. In the early and midterm follow up, risk factors, mortality and eventless survival rates were evaluated with this group of patients. Results: There were one stroke (3.3%) and three reversible neurological deficits (9.9%) in the early perioperative period. There was no early mortality. Carotid and aortic mean clamping times were 22 ± 6.8 min and 50 ± 14 min, respectively. Patients were discharged after a mean length of stay in intensive care unit (Icu) of 51 ± 4.5 hour and 7.4 ± 1.2 days of post-ICU hospitalization. Six hundred twelve patient-month follow up was realized in 87% of patients. Overall late mortality was 10% with three patients. There was one major stroke (3.3%) in the follow-up period. Conclusion: Combined interventions of carotid endarterectomy and aortocoronary bypass grafting can be performed with an acceptable morbidity and mortality when severe carotid stenosis is associated with advanced, symptomatic coronary artery disease.

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