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Simultaneous carotid endarterectomy and coronary revascularization
L Khaitan1, F P Sutter, S M Goldman
1Main Line Cardiothoracic Surgeons, Lankenau Hospital, Wynnewood, Pennsylvania 19066, USA.
Insights
Combined carotid endarterectomy and cardiac surgery effectively treats simultaneous carotid and cardiac disease in high-risk patients. This approach offers an acceptable method for correcting both conditions during a single procedure.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Neurosurgery
Background:
- Simultaneous surgical correction of carotid artery stenosis and cardiac disease presents unique challenges.
- A combined cardiac operation and carotid endarterectomy technique was developed to address these dual pathologies.
Purpose of the Study:
- To evaluate the safety and efficacy of a combined cardiac operation and carotid endarterectomy technique.
- To assess outcomes in a high-risk patient cohort requiring simultaneous intervention for carotid and coronary artery disease.
Main Methods:
- 121 consecutive patients underwent combined coronary artery bypass grafting and carotid endarterectomy (n=112) or with valve surgery (n=9).
- All patients had critical carotid artery stenosis (≥85%).
- A single aortic cross-clamp period was used with retrograde blood cardioplegia and systemic hypothermia for myocardial and cerebral protection.
Main Results:
- The mean cross-clamp time was 118 minutes.
- Perioperative cerebrovascular accidents occurred in 5.8% of patients, with 1.7% experiencing transient ischemic attacks.
- The overall procedure-related mortality rate was 5.8%.
Conclusions:
- The combined technique is a viable option for simultaneous repair of coronary and carotid lesions in high-risk patients.
- This approach demonstrates acceptable outcomes for managing concomitant cardiovascular and cerebrovascular disease.
Background:
Combined cardiac operation and carotid endarterectomy using our technique is an acceptable approach to simultaneous correction of both carotid and cardiac disease.
Methods:
From August 1989 to March 1998, 121 consecutive patients underwent combined operations. Of these patients, 112 had coronary artery bypass grafting and carotid endarterectomy, and 9 had coronary artery bypass grafting, carotid endarterectomy, and valve repair or replacement. All patients had a critical stenosis of 85% or more of the carotid artery. Mean age of the patients was 69.2 years; 80 patients were 65 years old or older. There were 88 men and 33 women. Notable risk factors included chronic obstructive pulmonary disease (19.8%), congestive heart failure (28%), preoperative myocardial infarction and unstable angina (66.9%). Of the patients, 20.7% had a stenosis of greater than 50% of the left main coronary artery. The technique used was correction of both the carotid and coronary lesions during a single aortic cross-clamp period using retrograde continuous blood cardioplegia for myocardial protection. Systemic hypothermia to 25 degrees C was used for cerebral protection.
Results:
Mean cross-clamp time was 118 minutes. Seven patients (5.8%) sustained perioperative cerebrovascular accidents. Two patients had transient ischemic attacks. The procedure-related mortality rate was 5.8%.
Conclusions:
The described technique is a good method for simultaneous repair of coronary and carotid lesions in a high-risk group of patients with concomitant disease. We will continue to use it.