Surgery for patients with diffuse atherosclerotis disease

Abstract

Objective: An increasing number of patients with peripheral and carotidal vascular disease are undergoing coronary artery bypass grafting. Such patients have an increased risk of adverse outcomes. Our aim was to quantify the effect of on time cardiopulmonary bypass in this group of patients. Methods: Between March 2006 and March 2012, 6090 consecutive patients underwent coronary artery bypass grafting; 1730 (28.4%) had combined coronary, peripheral and carotidal vascular disease We used multivariate logistic regression analysis to assess the effect of multimorbidity on post-operative in-hospital mortality and morbidity. Results: The primary combination was CABG with abdominal aortic aneurysm (AAA)in combination with cerebrovascular and peripheral vascular disease in 85 patients (4.9%), cerebrovascular disease (CVD) and CABG in 627pts(36.3%) and CABG and lower extremity ischemia in 673pts (38.9%), and combination of CABG and cerebrovascular and peripheral vascular disease in 345 pts (19.9%). All 1730 patients had severe correctable CAD. In patients with cerebrovascular, peripheral and combination with coronary artery disease, bypass surgery was performed after resolving of primary vascular disease. In group of patients with AAA, it was operated after resolving a vascular disease, and ate the end abdominal aneurysm was replaces with a graft. The overall operative mortality for 1730 operated patients with cardiac and peripheral vascular procedures was 1.7%(29pat). Like a postoperative complications stroke incidence was 1.5% (26 pts). Postoperative hospital stay was 5.5 days. Conclusions: Planned by-pass surgery is safe in patients with peripheral vascular disease, with acceptable results. The incidence of postoperative stroke is substantially reduced when avoiding cardiopulmonary bypass in patients with present carotidal disease and peripheral vascular disease.