同期不停跳冠脉旁路移植术与颈动脉内膜剥脱术治疗冠心病合并颈动脉狭窄的初步结果

Background Coronary and carotid artery diseases frequently coexist and patients with concomitant significant disease of coronary and carotid arteries remain at high risk of perioperative stroke and myocardial infarction after coronary bypass surgery. The aim of this study was to investigate the effect of combined carotid endarterectomy (CEA) and off-pump coronary artery bypass grafting on patients with carotid and coronary artery disease. Methods Consecutive patients with carotid and coronary artery disease underwent one-staged unilateral CEA and off-pump coronary artery bypass grafting between January 2002 and December 2007 in our heart institute. Perioperative complications including neurological events or major adverse cardiac events were assessed and follow-up was carried out. Results A total of 51 cases of isolated off-pump coronary artery bypass grafting and unilateral CEA including 34 right and17 left was performed. Mean blocked time of carotid artery in CEA was 25.5 ± 7 mins. Mean number of distal grafts per patient was 3.30 ± 0.45. Mean ventilation time，ICU stay and postoperative hospital stay were 11.3±5.4 hours，2.1 ± 0.9 days and 12.5 ± 6.1days respectively. None of the patients had stroke or myocardial infarct and there was one perioperative death due to acute cardiac failure, with operative mortality of 1.96%. Follow-up was complete in 47 patients (92.16%). After mean follow-up of 39.5 ±12.5 months (6～73 months) , none of patient manifested with stroke , new angina or new-born cardiac infarct and there was also no late death. Conclusions Concomitant off-pump coronary artery bypass grafting and CEA is a safe and effective procedure in selective patients with significant carotid and coronary artery disease.

The preliminary results of combined carotid endarterectomy and off-pump coronary artery bypass grafting in patients with carotid and coronary artery disease