|
Robert A. Lancey, M.D., James S. Gammie, M.D.,
& Bruce S. Cutler, M.D., University of Massachusetts Medical
School, Worcester, MA
Patients with symptomatic coronary artery disease who also require
a carotid endarterectomy at our institution have historically
undergone a combined coronary artery bypass / carotid endarterectomy
procedure. We have now extended this practice to our patients
who are candidates for off-pump surgery. Since August, 1999,
a total of 8 patients have undergone a combined procedure without
the use of cardiopulmonary bypass. The average age was 70.7 years,
and the mean ejection fraction was 48.1%. All patients had three-vessel
disease, and 62.5% were in New York Heart Association class IV.
One-half had a history of either a transient or permanent neurologic
event. The average number of distal anastomoses was 3.4, with
an average operating time of 414.4 minutes. Postoperative intubation
time averaged 19.6 hours, with an intensive care unit stay of
72.6 hours. Post-surgical length of stay averaged 7.6 days.
There were no postoperative neurologic deficits, myocardial infarctions,
or deaths. We have found this operation to be safe and effective
for treating patients with hemodynamically significant lesions
in both the cerebral and coronary circulations.
|
