Key result
Simultaneous CEA and cardiac surgery carries ~5% 30-day mortality, with contralateral occlusion predicting neurological complications.
Why the study?
The occurrence of severe carotid artery disease in more than 12% of patients requiring CABG creates uncertainty about the best treatment approach for both diseases.
What are the early neurological and mortality outcomes of simultaneous carotid endarterectomy and cardiac surgery?
Cohort (n=386)
What are the early neurological and mortality outcomes of simultaneous carotid endarterectomy and cardiac surgery?
Simultaneous carotid endarterectomy and cardiac surgery can be performed with a low risk of neurological complications, though contralateral carotid occlusion increases this risk.
May inform selective use of combined CEA-cardiac surgery; leaves open randomized comparison to staged strategies in contralateral occlusion.
Objectives: The occurence of severe carotid artery disease in more than 12% of patients requiering CABG results in a discrepany concerning best treatment for both diseases. We reviewed the early outcome of patients with CABG and/or valve replacement and simultaneous carotid endarterectomy (CEA). Methods: We retrospectiveley evaluated 386 pts operated simultaneously between 7/1993 and 4/2010.326 pts received isolated CABG, 56 CABG and/or valve replacement, 4 aortic surgery. Mean age was 68.3 years (range 45 to 87). 229 pts were males. 34% showed preoperatively symptomatic carotid stenosis (mostly TIA or Amaurosis fugax). Lesion at operated side was 70–80% in 167 pts, 80–99% in 219 pts.164 pts (42%) showed bilateral carotid stenosis, 56 of them >80%, 32 pts had contralateral occlusion. 14% were urgent operations. We analyzed risk factors, morbidity, incidence of neurological events and 30-day mortality. Results: Perioperative stroke with hemiplegia occured in 2.6% (10 pts).4 of them showed contralateral occlusion, 3 contralateral severe stenosis, 0.7% (3pts) experienced PRIND, 1.8% (7 pts) TIA. 30-day mortality was 5.2%. 8 deaths were cardiac related, 10 due to extracardial reasons, 3 pts developped a cerebral death. Conclusions: Simultaneous CEA and Cardiac Surgery can be performed with a low risk for neurological complications (superior to the recommended guidlines) and acceptable mortality. Occlusion of contralateral carotid artey could be identified as an evident predictor for increased neurological complications.
No takes yet. Share an insight, caveat, or question.
Gansera et al. (2011) conducted a cohort in Severe carotid artery disease requiring cardiac surgery (n=386). Simultaneous carotid endarterectomy and cardiac surgery was evaluated on 30-day mortality. Simultaneous carotid endarterectomy and cardiac surgery had a 2.6% rate of perioperative stroke and 5.2% 30-day mortality, with contralateral occlusion predicting neurological complications.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: