[Long-term outcomes of coronary artery bypass surgery in young patients]

One year outcomes following of carotid endarterectomy in different age groups: Russian multicenter study

Introduction

This is a retrospective analysis of the results of carotid endarterectomy (CEA) in different age groups.

Methods

This cohort, comparative, retrospective, open-label study for the period from 2008 to 2020 included 7248 patients with hemodynamically significant stenoses of the internal carotid artery (ICA), who underwent CEA. According to the classification of the World Health Organization, patients were divided into groups depending on age: up to 44 years-young age (n = 84); 45-60 years-middle age (n = 1635); 61-75-elderly age (n = 4817); over 75 years-senile age (n = 712).

Results

In terms of the frequency of hospital complications, the group of patients over 75 years of age experienced the largest number of cardiovascular events. One year after surgery, there were no significant differences in the incidence of complications between groups: death (group 1, 1.2%; group 2, 0.5%; group 3, 0.4%; group 4, 1%; p = 0.14), myocardial infarction (group 1, 1.2%; group 2, 0.3%; group 3, 0.14%; group 4, 0.3%; p = 0.12), stroke (group 1, 0%; group 2, 0.3%; group 3, 0.1%; group 4, 0.4%; p = 0.32).

Conclusion

The largest number of adverse cardiovascular events after CEA are observed among patients over 75 years of age, which is due to the high frequency of multivessel coronary lesions, atrial fibrillation, and the severity of the comorbidities. One year after surgery, there were no significant differences in the incidence of complications between groups.

[Hybrid revascularization in a patient with Covid-19 and chronic limb ischemia stage IV]

The authors report hybrid treatment of a patient with angina pectoris class II, multiple previous reconstructive interventions on the aortofemoral segment and chronic ischemia of the left lower limb stage IV and concomitant COVID-19. Coronary angiography was performed after regression of infectious disease under antiviral therapy. Occlusion of the left anterior descending artery was observed that required LAD stenting. On the next day, hybrid revascularization of the lower extremities was implemented: thrombectomy and endarterectomy from the branch of the aorto-femoral bypass graft and deep femoral artery at the first stage, stenting of the orifice of proximal branch of aorto-femoral bypass graft at the second stage, endarterectomy from superficial femoral artery, recanalization and stenting of superficial femoral artery and popliteal artery at the third stage and prosthetic- femoral bypass with autologous vein at the fourth stage. Postoperative angiography revealed patent stents and no residual stenoses. The choice in favor of these procedures and step-by-step approach has been substantiated. The authors emphasized effectiveness and safety of this treatment strategy.