Long-term results of surgical treatment of patients with combined atherosclerotic lesions of the coronary and carotid arteries

Objective. to compare the long-term results of surgical treatment of patients with coronary heart disease and concomitant lesions of the carotid arteries on a beating heart and under cardiopulmonary bypass. Materials and methods. The work is based on a prospective analysis of the results of surgical treatment of 143 patients who underwent a combined intervention - coronary bypass surgery and carotid endarterectomy. The patients were divided into two groups depending on the type of intervention: 74 (51.7%) patients operated on a working heart without cardiopulmonary bypass and 69 (48.3%) operated under conditions of cardiopulmonary bypass. Results. An analysis of the duration and quality of life of patients within 5 years after simultaneous operations on the carotid and coronary arteries on a beating heart showed a high survival rate (90.1%) with a rather low incidence of myocardial infarction - 4.6% and acute cerebrovascular accident - 3.8 % for the specified observation period. There were no significant differences in the annual dynamics of survival and rates of "freedom from the listed complications” after combined operations on a beating heart and under cardiopulmonary bypass. However, the combined rate of adverse cardiovascular events MACCE (recurrent angina, myocardial infarction, acute cerebrovascular accident, death) was significantly lower after simultaneous operations without cardiopulmonary bypass (11.6% vs. 25.8%, p = 0.043). Conclusion. Simultaneous coronary artery bypass grafting without cardiopulmonary bypass and carotid endarterectomy provide a high quality of life for operated patients in the long-term period, are accompanied by low mortality, as well as a lower complication rate.