Coronary and carotid occlusive disease--surgical techniques and results

In the period 1982-1996, 7,476 aortocoronary bypass surgeries were performed at the University Clinic for Cardiovascular Surgery in Novi Sad with perioperative mortality of 2.85%. In 242 patients (3.24%) an additional thrombendarterectomy procedure of carotid arteries was performed with indications such as: positive neurologic symptoms; critical morphology of carotid lesions according to Wesley-Moore symptomatology and critical stenosis. The cardiac status of patients was as follows: poor left ventricular function (EF--ejection fraction--30%) in 42 patients (19.2%), left main coronary artery stenosis in 31 patients (12.8%), endarterectomy of coronary arteries due to diffuse and distal coronary occlusive disease in 93 patients (38.5%) and isolated aortocoronary bypass in 149 patients (61.8%). The status of carotid arteries was as follows: unilateral stenosis in 156 patients and bilateral stenosis in 63. Depending on the carotid or cardiac finding, our surgical strategies differed: 65 patients (26.8%) underwent simultaneous operation, 141 patients (58.2%) underwent two-stage operation and in 36 patients (14.9%) three-stage operation was performed. Postoperative complications included: neurological deficit in 4 patients (1.7%); Transient ischemic attacks in 5 patients (2.1%); myocardial infarction in 6 patients (2.7%); hemorrhage in 2 patients (0.9%); gastrointestinal hemorrhage in 3 patients (1.4%); pulmonary complications in 2 patients (0.9%); serious rhythmic disorders in 1 patient (0.5%) and therapeutically resistant hypertension in 1 patient (0.5%). Ten patients (4.1%) died. Causes of death: cardiac in 3 patients (1.4%), neurological in 3 patients (1.4%), pulmonary embolism in 1 patient (0.5%) and other causes in 3 patients (1.4%). The operative risk in this group of polyvascular patients is higher than in the "group with isolated aortocoronary disease". Appropriate indications for surgery in one, two or three stages significantly decrease mortality in these patients. Simultaneous operation is reserved for patients with severe neurological symptoms and unstable angina.