The hybrid method of treatment of combined atherosclerotic lesions of the coronary and the brachiocephalic arteries

The authors presented immediate results of surgical treatment of patients with concomitant coronary and carotid arteries, which is hemodynamically significant. Since 2000 till 2012, 61 patients with concomitant atherosclerotic coronary and brachiocephalic arteries underwent one-stage operation. All patients were divided into 2 groups: Group 1 (21 patients, who underwent coronary bypass surgery combined with simultaneous stenting of the internal carotid artery), Group 2 (40 patients, who underwent coronary bypass surgery with carotid endarterectomy). In assessing intraoperative parameters revealed that in Group 1 the mean duration of surgery was lower (177.4±5.3 minutes vs. 271.6±5.6 minutes in Group 2) (p <0.001); and cardiopulmonary bypass time was less than in Group 2 (77.1±4.4 minutes vs. 113.2±4.1 minutes) (p<0.001). In Group 1 duration of artificial pulmonary ventilation was less than in Group 2 (9.29±1.7 h vs. 25.0±4.6 h) (p <0.01). Also in Group 1 was shorter duration of stay in the resuscitation department (24.1±3.8 h vs. 81.8±7.7 h in Group 2) (p<0.001). Overall hospital mortality was 12.5 % (5 patients), all the dead belonged to Group 2. The cause of death in three cases was acute myocardial infarction, one patient died from progressive multiple organ failure on the background of a stroke, and another cause of death was thrombosis of the mesenteric artery with the development of gangrene of the intestine and peritonitis. In the structure of hospital complications prevalent heart failure (14.3 and 57.5 % for Group 1 and 2, respectively, p <0.05). When analyzing the frequency and structure of other postoperative complications significant differences between groups were found. Our study demonstrates that the use of surgical treatments for patients with hemodynamically significant stenoses of the coronary and brachiocephalic arteries can increase overall survival in patients suffering from this disease, and reduce the incidence of ischemic coronary and cerebral circulation. A hybrid method of treatment for arteries of different vascular pools may be an alternative to carotid endarterectomy and coronary artery bypass, especially in patients with high surgical risk.

аортокоронарное шунтирование, стентирование сонной артерии, гибридная операция, ишемическая болезнь сердца, атеросклероз брахиоцефальных артерий, coronary artery bypass, carotid artery stenting, the hybrid operation, ischemic heart disease, atherosclerosis of the brachiocephalic arteries

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