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Simultaneous extensive extracranial and coronary revascularization. Long-term follow-up up to 13 years
F E Vermeulen1, R de Geest, H van den Pavoordt
1Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
Insights
This study found that simultaneous surgery for extracranial and coronary revascularization had a 3% operative mortality, primarily cardiac. Long-term survival was good, largely determined by cardiac outcomes, with 75% survival at 5 years.
Area of Science:
- Cardiovascular Surgery
- Neurological Surgery
- Vascular Surgery
Background:
- 168 patients underwent simultaneous extracranial and coronary revascularization between 1974 and 1987.
- High prevalence of severe cardiac disease (NYHA class III/IV, triple vessel disease, left main stem lesions) and prior myocardial infarctions.
- Significant proportion of patients had symptomatic extracranial disease, including bilateral carotid disease.
Purpose of the Study:
- To evaluate the outcomes of simultaneous surgery for combined extracranial and coronary revascularization.
- To assess operative mortality, morbidity, and long-term survival.
- To determine the factors influencing survival and morbidity in this patient cohort.
Main Methods:
- Retrospective analysis of 168 patients undergoing combined procedures.
- Data collection on patient demographics, preoperative conditions, surgical procedures, and outcomes.
- Actuarial analysis for survival and event-free rates at 5 and 10 years.
Main Results:
- Operative mortality was 3%, predominantly cardiac.
- Operative morbidity was mainly neurological (7%).
- Actuarial survival at 5 years was 75% and at 10 years was 57%, driven by cardiac survival rates.
- Neurological survival was high (97% at 5 years, 91% at 10 years).
- 5-year freedom from serious events or death was 72%, decreasing to 47% at 10 years.
Conclusions:
- Simultaneous extracranial and coronary revascularization is associated with acceptable operative risks.
- Long-term survival is primarily influenced by cardiac status.
- The procedure offers a viable option for patients with combined cerebrovascular and coronary artery disease, with good long-term neurological outcomes.
Abstract:
Simultaneous surgery for extensive extracranial and coronary revascularization was performed in 168 patients (mean age 61 years), from 1974 up to June 1987; 116 patients (69%) were in NYHA class III or IV, 133 (79%) had triple vessel disease and 51 (30%) had left main stem lesions. One or more previous myocardial infarctions were present in 96 patients (57%); normal preoperative left ventricular function was present in only 35%. In 22 cases, additional cardiac procedures were performed. Symptomatic extracranial disease was present in 76 patients (45%), arch vessel surgery was performed in 29 (17%) and bilateral haemodynamically significant carotid disease was present in 58 (35%). Operative mortality (3%) was mainly cardiac and operative morbidity mainly neurological (7%). Actuarial survival at 5 years (75%) and 10 years (57%) was mainly determined by the cardiac survival (87% at 5 years and 70% at 10 years), while neurological follow-up deaths were rare (neurological survival 97% at 5 years and 91% at 10 years). Late morbidity was more cardiac than neurologically determined; actuarial curves showed 72% to be free of all serious events or death at 5 years, and 47% at 10 years.