[The risk of neurological complications following aortocoronary bypass in patients with multifocal atherosclerosis].

Since January 1988 till June 1990 145 patients with combined coronary and vascular pathology have been operated on. Concomitant damage of aortic arch branches was observed in 54 patients (37.2%), and aortocoronary bypass surgery was performed in 40 patients without correction of the carotid vascular bed pathology. These patients comprised the basic group, which was divided into two subgroups depending on the clinical pattern of the disease: subgroup I--18 asymptomatic patients (45.0%), subgroup II--22 patients (55.0%) with clinical signs of the disease. The basic group comprised 257 patients with CHD alone and no damages of the aortic arch branches. In the postoperative period 10 out of 40 patients of the basic group developed neurological complications: brain hypoxia, delirious syndrome (3 patients); brain hypoxia, pre-comatose condition (3 patients); brain hypoxia, comatose condition (2 patients); transitory ischemic attack (2 patients). No significant differences in the development of complications have been observed in patients of both subgroups. In the control group neurological complications developed in 9 out of 257 patients (3.5%). The comparison of reasons responsible for the onset of complications in both groups has shown that acute heart failure was significantly predominant (10%) in the basic group, as compared to control group (1.9%). It has been concluded that after aortocoronary bypass surgery the risk of neurological complications was higher in patients with the accompanying damage of the aortic arch branches than in patients with CHD alone; the onset of acute heart failure in the early postoperative period increases the risk of neurological complications in such patients.