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.

PATIENTS AND 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.

CONCLUSION: 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.