Investigation of the tretament outcome and quality and life in patients with concomitant carotid and coronary artery disease regarding the sequence of surgical procedures

Abstract

UVOD: Istraživanja pokazuju da 3 do 10 % pacijenata sa koronarnom bolesti (KB) koji zahtevaju hirurško lečenje u smislu bajpasa na koronarnim arterijama (engl. coronary artery bypass grafting-CABG) imaju pridruženu karotidnu okluzivnu bolest (KOB). Hirurško lečenje bolesnika sa urduženom karotidnom i koronarnom okluzivnom bolesti još uvek nema ujednačen protokol i predstavlja veliki izazov za hirurge kako u svetu tako i u našoj zemlji. Algoritmi koji se nude kao operativna taktika nisu strogo definisani i vrlo često zavise od individualne procene hirurga i stava određenih ustanova koje izvode ove procedure. Prema našem saznanju, a imajući u vidu dostupnu literaturu, u našoj populaciji nema dovoljan broj studija koje su se odnosilo na ispitivanje uticaja redosleda hirurških intervencija (izolovane CABG i simultane CABG i karotidne endarterektomije (eng. Carotid endarterectomy (CEA)) na ishod lečenja kod osoba sa udruženom KB i unilateralnom asimptomatskom KOB. CILJ ISTRAŽIVANJA: Ciljevi istraživanja su bili: 1.ispitati ukupnu učestalost komplikacija (akutni infarkt miokarda (AIM); cerebrovaskularni insult (CVI); tranzitorni ishemijski atak (TIA), srčana insuficijencija, postoperativno krvarenje, infekcije operativnih rana, akutna bubrežna insuficijencija); 2. proceniti dužinu trajanja mehaničke ventilacije, dužinu boravka u jedinici intenzivne nege i ukupnu dužinu hospitalizacije u ispitivanim grupama; 3. izračunati postoperativni mortalitet u ispitivanim grupama; 4. ispititati promene kvaliteta života nakon sprovedenih hirurških intervencija u ispitivanim grupama. METOD: Studija je dizajnirana po tipu randomizovanog kliničkog eksperimenta u koju je bilo uključeno ukupno 118 pacijenata operisanih na Klinici za Kardiohirurgiju Kliničkog Centra Srbije u periodu od januara 2014 do januara 2016 godine. Osnovni kriterijum za uključivanje pacijenata u studiju su bili pacijenti sa asimptomatskom jednostranom stenozom zajedničke karotidne arterije ili unutrašnje karotidne arterije većom od 70%. Kriterijumi za elektivni koronarni bajpas je uključivao jednosudovnu, dvosudovnu i trosudovnu koronarnu bolest sa stenozom koronarnih arterija većom od 75% kao i hemodinamski značajnu stenozu glavnog stabla leve koronarne arterije. Bolesnici koji su zahtevali hitnu hiruršku revaskularizaciju miokarda, koji su preležali AIM i/ili CVI u periodu kraćem od mesec dana od uključenja u studiju kao i bolesnici sa predhodnom kardiohirurškom procedurom nisu bili uključeni u studiju...Literature data show that 3 to 10% of patients with coronary disease (CD) who require coronary artery bypass grafting (CABG) have coronary occlusive disease (COD). Surgical treatment of patients with concomitant carotid and coronary occlusive disease still has no uniform protocol and presents a major challenge for surgeons in the world both in our country. The algorithms offered as operating plan are not strictly defined and often depend on the individual assessment of the surgeon and the position of certain institutions that perform these procedures. According to our knowledge, no research has been performed in our population regarding the impact of the sequence of surgical interventions (isolated CABG and simultaneous CABG and carotid endarterectomy (CEA)) on the outcome of treatment in individuals with associated CD and unilateral asymptomatic COD. AIM: The objectives of the study were: 1.to investigate the overall incidence of complications (acute myocardial infarction; stroke; transient ischemic attack, cardiac failure, postoperative bleeding, operative wound infections, acute renal failure); 2. evaluate the duration of mechanical ventilation, the length of stay in the intensive care unit and the total length of hospitalization in the examined groups; 3. calculate postoperative mortality in the examined groups; 4. examine changes in the quality of life after surgical interventions in the examined groups. METHOD: The study was designed as randomized clinical experiment that included a total of 118 patients operated at the Clinic for Cardiac Surgery of the Clinical Center of Serbia in the period from January 2014 to January 2016. The main criteria for inclusion of patients in the study were patients with asymptomatic unilateral stenosis of the common carotid artery or internal carotid artery greater than 70%. The criteria for the elective coronary artery surgery included a single-sided, two-sided and three-hour coronary disease with coronary artery stenosis greater than 75% as well as haemodynamically significant stenosis of the main tree of the left coronary artery. Patients requiring urgent surgical revascularization of the myocardium, who had myocardial infarction and/or stroke over a period of less than one month after taking the study, as well as patients with a previous cardiac surgical procedure, were excluded from the study..

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