[Combined coronary artery bypass grafting and carotid endarterectomy: early postoperative results and perspectives].

OBJECTIVE: The aim of this study was to review early postoperative results of the combined coronary artery bypass grafting and carotid endarterectomy (CABG/CEA) performed at the Clinic of Cardiac Surgery Heart Center of Kaunas University of Medicine.

MATERIAL AND METHODS: A series of consecutive 19 patients (64.5+/-8.2 years old, 17 (89.5%) male patients) with coexisting severe ischemic cardiac and carotid artery disease were operated on during 8-year period ending December 2001. Seven (36.8%) patients with carotid artery stenosis were asymptomatic. Previous neurological events had occurred in 12 (63.2%) patients: five (26.4%) patients presented with a previous stroke, seven (36.8%) - with a transient ischemic attack. Demographics and perioperative variables of these patients were compared with variables of 42 patients, that underwent isolated CABG during this period (control group).

RESULTS: After introducing of the routine preoperative screening carotid ultra-sonography in the year 2000, the rate of asymptomatic carotid artery stenosis among all diagnosed hemodynamically significant carotid stenoses has raised up to 43.8%. The in-hospital results were similar between the two groups with regard to 30-day perioperative mortality, stroke and major postoperative complications.

CONCLUSIONS: Based on our results, combined interventions of CEA and CABG can be performed with an acceptable morbidity and mortality when severe carotid stenosis is associated with advanced, symptomatic ischemic heart disease. Patients with total occlusion of the carotid artery compose a high-risk subgroup for perioperative stroke. The introduction of routine preoperative carotid duplex scanning resulted in higher rate of asymptomatic carotid artery disease among the patients scheduled for combined CABG/CEA procedure.