Simultaneous coronary artery bypass grafting and vascular operations: early and mid-term results

The purpose of this study was to estimate the results of surgical strategy for patients undergoing simultaneous coronary and peripheral artery surgical interventions and to compare their early and mid-term clinical results with the results of the isolated coronary artery bypass grafting (CABG) operations.

From 1999 to 2005, 78 patients underwent simultaneous vascular reconstructions following CABG. All the patients were divided into 3 groups: CABG and carotid artery group (CAG), CABG and peripheral vascular group (PVG), and CABG and abdominal aortic aneurysm group (AAAG).

In CAG, early mortality was 2%, postoperative myocardial infarction and stroke rates were 2% and 6.1%, respectively. In PVG, one (4%) patient had postoperative stroke, and there were neither deaths nor myocardial infarctions. PVG and CAG did not differ significantly in postoperative complications and mortality rates from the isolated CABG group. The simultaneous abdominal aortic aneurysm operations were related to higher early mortality rate (2 out of 6). Using the Kaplan-Meier analysis, the 3-year overall survival probability in the simultaneous operation group was 82%; the 5-year overall survival probability, 74%. PVG and CAG did not differ in the survival probability from the isolated CABG group. The survival probability in AAAG was lower than in the isolated CABG group.

The simultaneous CABG and vascular operations whenever indicated are feasible procedures to be performed on patients with concomitant carotid artery and/or peripheral vascular occlusive disease. The surgical management of coronary artery disease followed by abdominal aortic aneurysm repair remains still controversial.