Combined open heart surgery and replacement of the brachiocephalic trunk. A safe method for simultaneous central
J Litmathe1, M Kurt, K Grabitz
1Department of Thoracic and Cardiovascular Surgery, Heinrich-Heine University, Moorenstrasse 5, 40225 Düsseldorf, Germany. litmathe@med.uni-duesseldorf.de
Insights
Combined open heart surgery and brachiocephalic trunk replacement is feasible and safe. This approach offers complete central revascularization with a low complication rate, making it a preferred surgical option.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
Background:
- Open heart surgery and central vascular surgery are often performed separately.
- The feasibility of combining these procedures requires investigation.
Purpose of the Study:
- To investigate the feasibility and outcomes of combined open heart surgery with brachiocephalic trunk replacement.
- To present 9 years of surgical experience with this combined approach.
Main Methods:
- Nine patients underwent combined procedures, including coronary artery bypass grafting or aortic valve replacement.
- Brachiocephalic trunk replacement was performed using Dacron prostheses.
- Two patients also had ipsilateral internal carotid artery desobliteration.
Main Results:
- No in-hospital deaths occurred.
- Median hospital stay was 15 days.
- Follow-up showed satisfactory cardiac status in five patients with no observed cerebral events or embolization.
Conclusions:
- Concomitant open heart surgery with brachiocephalic trunk replacement is a low-risk procedure.
- This combined approach allows for complete central revascularization.
- It is a preferred alternative to separate surgical interventions.
Objective:
We investigated the feasibility of open heart surgery with combined central vascular surgery and present the results from 9 years of experience.
Patients And Methods:
Of a total of nine patients, eight received coronary artery bypass grafting and one patient aortic valve replacement. Concerning vascular surgery a replacement of the brachiocephalic trunk using a Dacron prosthesis as an end-to-end anastomosis or as a bifurcations prosthesis was performed. Two patients underwent additional ipsilateral desobliteration of the internal carotid artery.
Results:
The hospital stay was between 8 and 30 days (median 15). The duration of the whole operation was median 318 min (range: 294-345 min), perfusion time 67 min (range: 62-146 min), myocardial ischemic time 27 min (range: 11-83 min). There was no case of in-hospital death. Follow-up was available up to 7.5 years in 7 patients. Five patients show a satisfactory cardiac status. A sign for ischemic cerebral events or embolization was not observed.
Conclusion:
Due to the low complication rate, we conclude that concomitant open heart surgery with replacement of the brachiocephalic trunk can be performed with low risk; it allows-in contrast to direct endarterectomy-complete central revascularization and hence should be preferred compared to surgical therapy in separate settings.
