Key result
Combined valvular and CEA surgery is linked to fewer subsequent strokes and CEAs versus isolated surgery.
Why the study?
Does combined valvular surgery and carotid endarterectomy reduce long-term stroke/TIA and future CEA compared to isolated valvular surgery in patients with asymptomatic carotid stenosis?
Cohort (n=1,012)
Does combined valvular surgery and carotid endarterectomy reduce long-term stroke/TIA and future CEA compared to isolated valvular surgery in patients with asymptomatic carotid stenosis?
p-value: p=<0.05
Combined valvular and carotid surgery in patients with severe asymptomatic carotid stenosis is safe and reduces long-term stroke/TIA and the need for future CEA compared to isolated valvular surgery.
May support combined surgery in asymptomatic stenosis; leaves open randomized confirmation of benefit.
We evaluated the prevalence of asymptomatic carotid artery disease in patients scheduled for valvular cardiac surgery. Preoperative screening of the carotid arteries was performed. Among 1012 patients scheduled for valvular cardiac surgery, 267 (26.4%) had carotid stenosis graded >50%; 37 had carotid stenosis >70% and underwent combined valvular surgery and carotid endarterectomy (CEA); and 230 (86%) had carotid stenosis >50% to ≤ 69% and received valvular cardiac surgery under hypothermic cardiopulmonary bypass. Operative mortality and the rate of perioperative adverse neurological events were comparable among the groups. During 6.8 years of follow-up, patients with carotid stenosis not exceeding 69% at the time of surgery had CEA more frequently (P < .05) and stroke/transient ischemic attack ([TIA] P < .05) versus patients treated with combined surgery. The prevalence of asymptomatic carotid stenosis is not negligible in patients undergoing isolated valvular surgery. Combined valvular and carotid surgery is safe and reduces the incidence of CEA and stroke/TIA during follow-up.
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Anselmi et al. (2011) conducted a cohort in Asymptomatic carotid artery disease in patients scheduled for valvular cardiac surgery (n=1,012). Combined valvular surgery and carotid endarterectomy (CEA) vs. Isolated valvular cardiac surgery was evaluated on Incidence of CEA and stroke/transient ischemic attack (TIA) during follow-up (p=<0.05). Combined valvular and carotid surgery reduced the incidence of subsequent carotid endarterectomy and stroke/TIA compared to isolated valvular surgery during 6.8 years of follow-up (P<0.05).
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