Off pump concomitant coronary revascularization and carotid endarterectomy

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery

Background:

• Patients with significant coronary and carotid artery disease present a complex management challenge.
• Off-pump coronary artery bypass (OPCAB) is a viable surgical option.
• Carotid endarterectomy (CEA) is a standard procedure for carotid artery disease.

Purpose of the Study:

• To evaluate the safety and efficacy of combined carotid endarterectomy (CEA) and off-pump coronary artery bypass (OPCAB).
• To compare outcomes of combined OPCAB/CEA with isolated off-pump procedures.

Main Methods:

• A prospectively updated database was queried for patients undergoing combined OPCAB/CEA between 1999 and 2002.
• 38 patients undergoing combined procedures were identified.
• These patients were compared to contemporaneous cohorts of isolated off-pump patients with and without cerebrovascular disease.

Main Results:

• The study population had a mean age of 71 years, with a high prevalence of left main disease and reduced ejection fractions.
• The combined OPCAB/CEA group experienced 1 postoperative myocardial infarction and no postoperative cerebrovascular accidents (CVA).
• In-hospital mortality was 3%, with no significant differences in mortality compared to control groups.

Conclusions:

• Combined OPCAB/CEA appears to be a safe procedure for patients with coexisting coronary and carotid artery disease.
• This approach may reduce the risk of postoperative stroke.
• Potential economic benefits include shorter hospitalizations and avoidance of a second procedure, though further randomized trials are needed.