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The Annals of Thoracic Surgery, Vol 53, 381-389, Copyright © 1992 by The Society of Thoracic Surgeons
FE Vermeulen, RP Hamerlijnck, JJ Defauw and SM Ernst
The late follow-up of 230 patients who underwent synchronous operation for
extensive, obstructive extracranial and coronary artery disease from 1974
to 1989 was analyzed. Mean age at operation was 62.5 years; 161 patients
(70%) were in New York Heart Association class III or IV, 185 (80%) had
triple-vessel disease, and 67 (29%) had left main stem lesions of 50% or
more. Previous myocardial infarctions were present in 132 patients (57%).
Only 78 had normal left ventricular function. Included were 16 patients
undergoing coronary reoperations, 17 patients with additional cardiac
procedures, and 3 with synchronous pulmonary procedures. Symptomatic
extracranial vascular disease or stabilized neurological deficits were
present in 108 patients. Bilateral hemodynamically significant carotid
disease was present in 91 patients and arch vessel lesions in 37. The
hospital mortality in 8 patients (3.5%) was due to cardiac (n = 4),
neurological (n = 1), or multiorgan failure (n = 3). Operative morbidity
was mainly neurological (n = 20, 8.7%): 7 reversible deficits and 7 major
strokes occurred, 2 reversible and 5 major strokes were related to the
operated side(s), and 4 postoperative myocardial infarctions occurred.
Actuarial survival at 5 years was 74% (+/- 3.3), at 10 years 54% (+/- 4.9),
and at 15 years, 35% (+/- 6.6). This was mainly determined by late cardiac
death (41/66). Late morbidity was mainly attributable to cardiac causes
rather than neurological causes. At 5 and 10 years, respectively, 72% and
44% of the patients were free of major cardiac and neurological events or
death. Synchronous revascularization can be performed relatively safely.
The long-term outcome is determined by the extent and severity of the
cardiovascular disease.
ARTICLES
Synchronous operation for ischemic cardiac and cerebrovascular disease: early results and long-term follow-up
Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
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