Extra-anatomic revascularization for preoperative XXXX due to distal carotid artery occlusion in @entity697   .

@entity1 @entity697 @entity295 @entity64 @entity548 @entity2293 @entity16 @entity260 @entity177 @entity3481 @entity51 @entity1576 @entity432 @entity850 @entity1779
OBJECTIVES: Management of @entity1 with @entity697 ( @entity697 ) and @entity1779 secondary to occlusion or @entity850 of the left common carotid artery (LCCA) or right common carotid artery (RCCA) is a significant challenge. The aim of this study is to present our institutional strategy and postoperative results for this high-risk @entity1 cohort. METHODS: Between November 2005 and July 2013, 23 of 354 consecutively operated @entity697 @entity1 [median age: 66.3; interquartile range (IQR): 55.2-69.9] suffered from @entity1779 due to bilateral (n = 1) or unilateral occlusion of the LCCA/RCCA (n = 22). @entity697 repair comprised hemi- (n = 14) or total (n = 9) arch replacement in combination with aortic valve repair (n = 7) or replacement (n = 11), root replacement (n = 15) and coronary bypass (n = 3). Extra-anatomic aorto-carotid bypass was performed in all @entity1 . Aorto-carotid bypass was performed at the beginning of the procedure to allow for unilateral selective cerebral perfusion (n = 17; 73.9%) or during the procedure if persisting malperfusion was suspected by near-infrared spectroscopy (n = 6; 26.1%). RESULTS: The median follow-up was 15.2 months (IQR: 4.8-34.1) and 100% complete. Median hospital stay and ICU stay were 16.0 (IQR: 12.5-26.0) and 13.7 (IQR: 2.0-16.5) days, respectively. Rethoracotomy for @entity548 or @entity2293 was performed in 6 (26.1%) @entity1 . Other @entity260 comprised low cardiac output with extracorporeal membrane oxygenation (n = 2; 8.7%), @entity295 (n = 4; 17.4%), @entity1576 (n = 10; 43.5%), @entity177 with temporary dialysis (n = 7; 30.4%) and visceral malperfusion (n = 2; 8.7%) requiring stent grafting (n = 1) or laparotomy with intestinal resection (n = 1). @entity64 with or without permanent @entity3481 was diagnosed in 8 (34.8%) @entity1 . @entity51 were seen in 9 (39.1%) individuals. Hospital and 1-year mortality rates were 13.0 and 30.4%, respectively. Overall survival after 36 months of the 23 @entity1 (Group I = Extra-anatomic bypass) versus the remaining 331 @entity697 @entity1 without @entity432 (Group II = no extra-anatomic bypass) was 69.6% (n = 16) in Group I vs 72.5% (n = 240) in Group II (P = 0.90). CONCLUSION: Extra-anatomic bypass for LCCA or @entity432 allows for early selective cerebral perfusion during @entity697 repair, and may reduce the risk of @entity16 in @entity1 with preoperative @entity1779 .
