Key result
Preoperative carotid screening in asymptomatic patients undergoing isolated heart valve surgery yielded a low prevalence of significant ICA disease (2.81%), suggesting no benefit from screening.
Why the study?
Does preoperative carotid duplex screening predict postoperative neurological events in neurologically asymptomatic patients undergoing isolated heart valve surgery?
Observational (n=177)
Does preoperative carotid duplex screening predict postoperative neurological events in neurologically asymptomatic patients undergoing isolated heart valve surgery?
Routine preoperative carotid screening in neurologically asymptomatic patients undergoing isolated heart valve surgery has a very low yield and does not predict postoperative neurological events.
Answers are grounded in this paper and cite their sources.
Should not prompt routine carotid screening in asymptomatic valve surgery; leaves open value of selective approaches in higher-risk subgroups.
OBJECTIVE: To assess the yield of screening for asymptomatic carotid artery disease prior to isolated heart valve surgery (IHVS). METHODS: Retrospective analysis of the preoperative carotid duplex scans performed in neurologically asymptomatic patients who underwent IHVS between 2003 and 2006 was performed. Internal carotid artery (ICA) stenosis of 70% was considered significant. Patients with concomitant coronary artery disease were excluded. RESULTS: A total of 177 patients underwent IHVS (one valve in 165 and 2 valves in 12 patients). No or minor ICA disease detected in 172 patients. Four patients (2.25%) had significant unilateral ICA stenosis and 1 patient (0.56%) had unilateral ICA occlusion. Three patients (1.69%) suffered postoperative stroke, while 2 patients (1.1%) suffered transient ischemic attacks. All neurologically affected patients had normal preoperative carotid duplex. The in-hospital mortality was 4.5%. CONCLUSION: Prevalence of significant ICA disease is low in patients undergoing IHVS. This population does not benefit from preoperative carotid screening.
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Zayed et al. (2008) conducted an observational in Asymptomatic carotid artery disease prior to isolated heart valve surgery (n=177). Preoperative carotid duplex screening was evaluated on Significant internal carotid artery (ICA) stenosis (≥70%) or occlusion. Preoperative carotid screening in asymptomatic patients undergoing isolated heart valve surgery yielded a low prevalence of significant ICA disease (2.81%), suggesting no benefit from screening.
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