The Thoracic and cardiovascular surgeon · 2012
Simultaneous carotid endarterectomy and cardiac surgery: early results of 386 patients.
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Gansera Brigitte, Schmidtler Fabian, Weingartner Josef, Kiask Theodor, Gundling Felix, Hapfelmeier Alexander, Eichinger Walter
Аннотация
BACKGROUND: The occurrence of severe carotid artery disease in more than 12% of patients requiring coronary artery bypass grafting (CABG) results in a discrepancy concerning best treatment for both diseases. We reviewed the early outcome of patients with CABG and/or valve replacement (VR) and simultaneous carotid endarterectomy (CEA).
METHODS: We retrospectively evaluated 386 patients after simultaneous operation between 7/1994 and 9/2010. Total 326 patients received isolated CABG, 56 CABG and/ or VR, 4 aortic surgery. Mean age was 68.3 years (range: 45 to 87). Male patients were 229. Severity of stenosis at operated side was 70 to 80% in 167, 80 to 99% in 219 patients. Total 164 patients showed bilateral carotid stenosis, 32 had contralateral occlusion. We analyzed risk factors, morbidity, incidence of neurological events, and 30-day mortality.
RESULTS: Perioperative stroke with hemiplegia occurred in 10 patients (2.6%). Three patients experienced PRIND, seven TIA. A 30-day mortality was 5.2%. Total 8 deaths were cardiac related, 10 due to extracardial reasons, and 2 patients developed a cerebral death.
CONCLUSIONS: Simultaneous CEA and cardiac surgery can be performed with a low risk for neurological complications and acceptable mortality. Occlusion of contralateral carotid artery could be identified as an evident predictor for increased neurological complications.
METHODS: We retrospectively evaluated 386 patients after simultaneous operation between 7/1994 and 9/2010. Total 326 patients received isolated CABG, 56 CABG and/ or VR, 4 aortic surgery. Mean age was 68.3 years (range: 45 to 87). Male patients were 229. Severity of stenosis at operated side was 70 to 80% in 167, 80 to 99% in 219 patients. Total 164 patients showed bilateral carotid stenosis, 32 had contralateral occlusion. We analyzed risk factors, morbidity, incidence of neurological events, and 30-day mortality.
RESULTS: Perioperative stroke with hemiplegia occurred in 10 patients (2.6%). Three patients experienced PRIND, seven TIA. A 30-day mortality was 5.2%. Total 8 deaths were cardiac related, 10 due to extracardial reasons, and 2 patients developed a cerebral death.
CONCLUSIONS: Simultaneous CEA and cardiac surgery can be performed with a low risk for neurological complications and acceptable mortality. Occlusion of contralateral carotid artery could be identified as an evident predictor for increased neurological complications.
Предметные рубрики MeSH
AgedAged, 80 and overCarotid StenosisCause of DeathChi-Square DistributionCoronary Artery BypassCoronary Artery DiseaseEndarterectomy, CarotidFemaleHeart Valve DiseasesHeart Valve Prosthesis ImplantationHemiplegiaHumansIschemic Attack, TransientMaleMiddle AgedOdds RatioRetrospective StudiesRisk AssessmentRisk FactorsSeverity of Illness IndexStrokeTime FactorsTreatment Outcome