Combined open heart surgery and replacement of the brachiocephalic trunk. A safe method for simultaneous central revascularization.
OBJECTIVE
We investigated the feasibility of open heart surgery with combined central vascular surgery and present the results from 9 years of experience.


METHODS
Of a total of nine patients, eight received coronary artery bypass grafting and one patient aortic valve replacement. Concerning vascular surgery a replacement of the brachiocephalic trunk using a Dacron prosthesis as an end-to-end anastomosis or as a bifurcations prosthesis was performed. Two patients underwent additional ipsilateral desobliteration of the internal carotid artery.


RESULTS
The hospital stay was between 8 and 30 days (median 15). The duration of the whole operation was median 318 min (range: 294-345 min), perfusion time 67 min (range: 62-146 min), myocardial ischemic time 27 min (range: 11-83 min). There was no case of in-hospital death. Follow-up was available up to 7.5 years in 7 patients. Five patients show a satisfactory cardiac status. A sign for ischemic cerebral events or embolization was not observed.


CONCLUSIONS
Due to the low complication rate, we conclude that concomitant open heart surgery with replacement of the brachiocephalic trunk can be performed with low risk; it allows-in contrast to direct endarterectomy-complete central revascularization and hence should be preferred compared to surgical therapy in separate settings.
Litmathe
J
J
Department of Thoracic and Cardiovascular Surgery, Heinrich-Heine University, Moorenstrasse 5, 40225 Düsseldorf, Germany. litmathe@med.uni-duesseldorf.de
Kurt
M
M
Grabitz
K
K
Schmitt
H-H
HH
Sandmann
W
W
Gams
E
E
D000368:Aged; D001021:Aortic Valve / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000601:surgery*; D001157:Arterial Occlusive Diseases / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D016122:Brachiocephalic Trunk / Q000601:surgery*; D016893:Carotid Stenosis / Q000601:surgery; D003131:Combined Modality Therapy; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000601:surgery*; D005112:Extracorporeal Circulation; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged