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The Journal of Thoracic and Cardiovascular Surgery, Vol 85, 577-589, Copyright © 1983 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
NR Hertzer, FD Loop, PC Taylor and EG Beven
Simultaneous coronary artery bypass and carotid endarterectomy were
performed in 331 patients (mean age 61 years) at the Cleveland Clinic from
1973 through 1981. Of these, 195 (59%) had Functional Class III-IV angina
pectoris, 308 (93%) had multiple-vessel coronary artery disease (CAD), 68
(21%) had over 50% stenosis of the left main coronary artery, and 185 (56%)
had either segmental or diffuse impairment of left ventricular function.
Asymptomatic carotid stenosis was documented in 173 patients (52%), and the
remaining 158 had experienced either previous transient cerebral ischemia
(38%) or completed strokes (10%). Single aorta-coronary grafts were placed
in 59 patients (18%), double grafts in 131 (40%), and three or more grafts
in 141 (42%). Nineteen patients (5.7%) died postoperatively in the
hospital. Neurologic deficits occurred in 30 patients (9.0%) and produced
permanent functional impairment in 15 (4.5%). Late results have been
obtained for 312 operative survivors at a mean postoperative interval of 38
months. Thirty-eight patients (12%) have died, but the 5 year life-table
survival rate of the study group was identical to that of the normal
population aged 61 years. Significant differences in cumulative 5 year
survival rates were identified among diabetic patients (p less than 0.025)
and among those receiving single rather than double (p less than .005) or
multiple (p less than .01) coronary grafts. Although 18 patients (5.8%)
have had late strokes, only five (1.6%) of these strokes have involved the
cerebral hemisphere on the same side as combined carotid endarterectomy.
ARTICLES
Combined myocardial revascularization and carotid endarterectomy. Operative and late results in 331 patients
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