Synchronous carotid and coronary bypass surgery using minimal extracorporeal circulation does not increase the risk of in-hospital stroke compared to isolated carotid endarterectomy under general anaesthesia

Gebiet: Chirurgie Abstract: Introduction: Carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG) could be approached in a combined or a staged fashion. Some crucial studies have shown no significant difference in peri-operative stroke and death rate in combined versus staged CEA/CABG. At present conventional extracorporeal circulation (CECC) is regarded as the gold standard for performing on-pump coronary artery bypass grafting. On contrary, the use of minimized extracorporeal circulation (MECC) for CABG diminishes hemodilution, blood-air contact, foreign surface contact and inflammatory response. At the same time, general anaesthesia (GA) is a potential risk factor for higher perioperative stroke rate after isolated CEA, not only for the ipsilateral but also for the contralateral side especially in case of contralateral high-grade stenosis or occlusion. The aim of the study was to analyze if synchronous CEA/CABG using MECC (CEA/CABG group) allows reducing the perioperative stroke risk to the level of isolated CEA performed under GA (CEA-GA group). – Methods: A retrospective analysis of all patients who underwent CEA at our institution between January 2005 and December 2012 was performed. We compared outcomes between all patients undergoing CEA/CABG to all isolated CEA-GA during the same time period. The CEA/CABG group was additionally compared to a reference group consisting of patients undergoing isolated CEA in local anaesthesia. Primary outcome was in-hospital stroke. – Results: A total of 367 CEAs were performed, from which 46 patients were excluded having either off-pump CABG or other cardiac surgery procedures than CABG combined with CEA. Out of 321 patients, 74 were in the CEA/CABG and 64 in the CEA-GA group. There was a significantly higher rate of symptomatic stenoses among patients in the CEA-GA group (p<0.002). Three (4.1%) strokes in the CEA/CABG group were registered, two ipsilateral (2.7%) and one contralateral (1.4%) to the operated side. In the CEA-GA group 2 ipsilateral strokes (3.1%) occurred. No difference was noticed between the groups (p=1.000). One patient with stroke in each group had a symptomatic stenosis preoperatively. – Conclusions: Outcome with regard to mortality and neurologic injury is very good in both -patients undergoing CEA alone as well as patients undergoing synchronous CEA and CABG using the MECC system. Although the CEA/CABG group showed slightly increased risk of stroke, it can be considered as combined treatment in particular clinical situations.

Real Cedula de su Magestad de 11. de Enero 1797 : sobre visita y ereccion de nueva Junta de Gobierno, en el Real Hospital General de Valencia

Esc. real en port.

Alegacion por el Dr. Joseph Camarasa, rector de la parroquial Iglesia de San Martin Obispo de esta ciudad ... contra los administradores del Hospital General de la misma ciudad ..., su vicario y sus capellanes ... en la causa ... de dicha iglesia ... en el referido Hospital General ..

Precede al tít.: "J.M.J."

Don Lorenzo Martinez, abogado de los Reales Consejos, escribano ... de esta su Corte y Audiencia ... de Valencia, y secretario de acuerdo y gobierno de la misma ... certifico : que en el Real Acuerdo de esta Audiencia se formó expediente ... a instancia de la Junta de Direccion y Gobierno del Santo Hospital Real y General de esta ciudad, en solicitud de que se guardasen los privilegios concedidos a los Demandaderos y Limosneros de dicho establecimiento

Certificado expedido Valencia a 16 de mayo de 1828, que tiene estampado el sello de pobres en la cabecera

Capitulos acordados por la...Administracion del Hospital Real y General de...Valencia en...30 de Noviembre del...1770 para el establecimiento de un posito o caudal destinado para...abastos que se necesitan para la asistencia...de los...enfermos...

Tit. tomado del comienzo del texto

Cedula de Sanidad que concede el Santo Hospital General de Valencia à muchas de las Poesias, que adornaron las calles ... en la passada Fiesta de la tercera Centuria de la Canonizacion de San Vicente Ferrer, celebrada en 29 de Junio de 1755

Tít. tomado de principio de texto

Discurso que con motivo de colocar ... el retrato de D. Fernando VII en el nuevo local que para el estudio de medicina clínica ha destinado la ... Junta de Gobierno del Real Hospital General de esta ciudad

En el título consta el año 1827

La oracion de Jesus en el huerto [Material gráfico] :1er origen de la Cofradia y Hermandad de la Agonia fundadas en el Hospital General de Valencia

Resumen: Descripción: Jesús en el huerto de rodillas y de espaldas mira hacia arriba donde un ángel le muestra la Cruz y el cáliz, mientras tres discípulos duermen a su alrededor

A la piedad y proteccion de los ... Iurados, Racional ... y insigne Consejo de la ... ciudad de Valencia, Vicente Sans Cutanda ... Mayordomo en este año de 1652 en 1653 de la Casa y Hospital General ... propone el misero [Texto impreso] ...]

Sign.: A-F2

El Hospital General de Atocha de Madrid

El Hospital General de Atocha de Madrid

[Aviso al público anunciando la celebración de tres corridas de toros a beneficio del Hospital General de Valencia] [Texto impreso]

Preside la corrida Don Francisco Xavier de Azpiroz