Combined innominate artery reconstruction and coronary artery bypass grafting

Area of Science:

• Cardiovascular Surgery
• Neurological Surgery
• Vascular Surgery

Background:

• Significant coronary artery disease often coexists with cerebrovascular disease.
• Innominate artery near-total occlusion poses a risk for neurological deficits like syncope or stroke.
• Protecting both the myocardium and cerebrum during cardiac surgery is critical.

Observation:

• Two patients with severe coronary artery disease and innominate artery occlusion experienced neurological symptoms.
• Both patients underwent a successful one-stage surgical reconstruction.
• The procedure involved aorto-carotid-subclavian bypass and coronary artery bypass grafting (CABG).

Findings:

• Cerebral perfusion was maintained via the reconstructed carotid bypass graft during cardiac arrest and hypothermia.
• Follow-up angiography showed extensive improvement in previously hypoperfused cerebral hemispheres.
• Patients were free from cerebral deficits and coronary angina post-surgery.

Implications:

• Combining innominate artery reconstruction with coronary artery surgery is a feasible and effective strategy.
• This surgical approach offers acceptable mortality and morbidity rates.
• Maintaining cerebral perfusion during cardiac arrest is key to successful outcomes in complex cardiovascular procedures.