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Prophylactic Cardiac andVascular
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Surgery Procedures
TahirYağdı , MustafaÖzbaran ,
andÇağatayEngin
30
30.1 Introduction
Cardiovascular diseases are the leading causes of
mortality, being responsible for approximately
one-third of all deaths globally. Diseases concerning the eld of cardiovascular surgery are
mostly the coronary artery diseases, carotid
artery diseases, valvular heart diseases, cardiac
tumors, aortic aneurysms and peripheral arterial
diseases. Patients may remain asymptomatic for
a long period of time before the diagnosis. Thus,
especially in the high-risk group of patients, periodical laboratory tests and further relevant interventions should be made in time, since a delay
can lead to gradual deterioration of the patients.
The two principal purposes of surgical therapy
for this special patient population are: increase
survival rates and improvement of the symptoms.
This chapter provides a brief summary about the
aforementioned diseases and the preventive surgical strategies, particularly in patients without
symptoms.
T. Yağdı (*) · M. Özbaran · Ç. Engin
Department of Cardiovascular Surgery, School of
Medicine, Ege University, Izmir, Turkey
e-mail: tahir.yagdi@ege.edu.tr;
mustafa.ozbaran@ege.edu.tr;
cagatay.engin@ege.edu.tr
30.2 Coronary Artery Disease
Coronary artery disease, besides being one of the
most important causes of mortality, is also one of
the most frequently seen pathology in patients
who undergo cardiac surgery. Risk factors such
as older age, male gender, hypertension, diabetes
mellitus, hypercholesterolemia, smoking, alcohol, obesity, unhealthy diet and nutrition, insufcient physical activity, family history and
genetic predisposition and stress are commonly
seen in patients with coronary artery disease.
Coronary artery disease is a serious condition
which requires immediate treatment either by
medically or surgically. In surgical point of view,
the approach is to revascularization of the ischemic area. The principal goals of surgical revascularization for patients with coronary artery
disease are to increase survival and to reduce
symptoms [1, 2].
Coronary artery bypass grafting to improve
survival is recommended for patients with more
than 50% diameter stenosis of left main coronary artery [3]. Coronary artery bypass grafting
to improve survival is also useful in patients having no symptom and with more than 70% diameter stenosis in three major coronary arteries or
in the proximal left anterior descending artery
with one of the other major coronary arteries
(Fig.30.1) [4]. Coronary artery bypass grafting
also could be useful to increase survival in
asymptomatic patients with signicant stenosis
in two major coronary arteries with severe or
© The Author(s), under exclusive license to Springer Nature Switzerland AG 2021
O. N. Dilek et al. (eds.), Prophylactic Surgery, https://doi.org/10.1007/978-3-030-66853-2_30
359
360
Fig. 30.1 Completed coronary artery bypass grafting
operation performed with cardiopulmonary bypass via
median sternotomy.*: LIMA graft to LAD; **: saphenous
graft to D
nous graft to OM
left internal mammary artery, LAD left anterior descending artery, D
ginal branch, OM
right coronary artery)
; ***: saphenous graft to RCA; ****: saphe-
1
; *****: saphenous graft to OM2. (LIMA
1
rst diagonal branch, OM1 rst obtuse mar-
1
second obtuse marginal branch, RCA
2
extensive myocardial ischemia or target coronary arteries supplying a sizeable region of viable myocardium [5].
T. Yağdı et al.
Fig. 30.2 3D reconstruction image of preocclusive
carotid stenosis of internal carotid artery on CT angiographic examination (CCA common carotid artery, ICA
internal carotid artery, ECA external carotid artery)
subtraction angiography (DSA). Precise estimation of the stenosis is usually made with CTA
(Fig.30.2).
Following the diagnosis, surgical removal of
the atherosclerotic plaque is essential. Additionally,
concomitant carotid artery endarterectomy in
patients who undergo coronary artery bypass procedure is strongly recommended. Coronary artery
bypass and carotid endarterectomy can be done
either simultaneously or staged [7].
30.3.2 Carotid Body Tumors
30.3 Carotid Artery Diseases
30.3.1 Carotid Artery Stenosis
Carotid artery stenosis is well-known atherosclerotic process and is one of the main reasons
of cerebrovascular accident. The asymptomatic
carotid atherosclerosis study (ACAS) has conrmed that carotid endarterectomy is useful for
the decrease of neurologic sequalae in patients
with signicant carotid stenosis from 18% to
7% over 5 years [6]. Numerous diagnostic tools
exist for assessment of the disease, such as color
Doppler ultrasonography, computed tomography angiography (CTA), magnetic resonance
angiography (MRA) and intra-arterial digital
Carotid body tumors are rarely seen clinical entities, which are generally located at the bifurcation of the common carotid artery as
neuroendocrine neoplasms [8]. They are frequently located unilaterally and mostly have a
benign nature. They can be seen both in men and
women with equal proportions. Clinical presentation of the disease is variable. Approximately,
two-third of the patients present with an asymptomatic mass on the neck, located alongside the
sternocleidomastoid muscle. Since the process of
progression is quite slow, patients often remain
asymptomatic for a long period of time.
Vascular tumors originating from the chemoreceptor cells located at the carotid artery bifurcation are dense. Thus, surgical excision is
considered as a potentially dangerous procedure.
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