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Simultaneous carotid and coronary artery surgery: indications and perioperative outcome
M Horst1, H J Geissler, U Mehlhorn
1Center for Cardiothoracic Surgery, University of Cologne, Germany. sk.horstmi@sk.netcologne.de
Insights
Combined carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG) is safe for patients with both conditions. The procedure showed low cerebral complication rates, with cardiac issues being the primary concern.
Area of Science:
- Cardiovascular Surgery
- Neurological Surgery
Background:
- Coexistence of coronary artery disease (CAD) and carotid artery disease (CAD) presents a high-risk surgical scenario.
- Patients with both CAD and CAD face increased risks of cardiac and cerebral complications.
Purpose of the Study:
- To evaluate the perioperative outcomes of combined single-stage carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG).
Main Methods:
- Retrospective analysis of 63 patients undergoing simultaneous CEA and CABG between 1989 and 1998.
- Carotid endarterectomy (CEA) was performed before coronary artery bypass grafting (CABG) and cardiopulmonary bypass initiation.
Main Results:
- The perioperative mortality rate was 7.9%, primarily due to cardiac complications.
- A low rate of reversible neurological symptoms (1.7%) was observed, with no permanent cerebral damage.
- Patient outcomes were predominantly influenced by cardiac complications.
Conclusions:
- Combined single-stage CEA and CABG demonstrates a safe approach for patients with concomitant CAD and CAD.
- The procedure is associated with low cerebral morbidity.
- Cardiac complications are the main determinant of patient outcomes in this combined surgical approach.
Background:
A significant number of patients with coronary artery disease is diagnosed with additional carotid artery disease. This subset of patients has been identified as a high-risk group for cardiac and cerebral complications following surgical intervention.
Methods:
In a retrospective analysis we investigated the perioperative outcome of combined single-stage carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG) in 63 patients operated between January 1989 and August 1998. In all of these patients, CEA was performed prior to CABG and before initiation of cardiopulmonary bypass.
Results:
Perioperative mortality rate was 7.9% (5/63) for simultaneous CEA and CABG and was due to cardiac complications in all patients. Postoperative unilateral neurological symptoms were diagnosed in 1 patient (1.7%) and were completely reversible. No neurologic events suggestive for permanent cerebral damage were observed during the 30 d postoperative period.
Conclusions:
In our study combined single-stage CEA and CABG was associated with low cerebral morbidity and patient outcome was mainly determined by cardiac complications. In this subset of patients, simultaneous CEA and CABG appears to be a safe method.
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