[Simultaneous carotid endarterectomy and cardiac surgery-additional risk factor or safe procedure?]

Area of Science:

• Cardiovascular Surgery
• Neurology
• Vascular Surgery

Background:

• Severe carotid artery disease affects over 12% of patients undergoing aortic valve replacement (AVR).
• Optimal treatment strategy for concurrent severe carotid artery disease and cardiac conditions remains debated.
• This study reviews early outcomes of combined aortic valve replacement and carotid endarterectomy (TEA).

Purpose of the Study:

• To evaluate the early outcomes of simultaneous aortic valve replacement (AVR) and carotid endarterectomy (TEA).
• To identify predictors of neurological complications in patients undergoing combined procedures.
• To compare the safety and efficacy of combined versus staged procedures.

Main Methods:

• Retrospective analysis of 244 patients undergoing simultaneous AVR and/or valve replacement with TEA between July 1994 and October 2001.
• Analysis included risk factors, perioperative morbidity, neurological complications, and 30-day mortality.
• Patients' mean age was 68 years, with 188 males.

Main Results:

• Perioperative stroke with hemiplegia occurred in 3.3% of patients.
• Contralateral carotid artery occlusion was identified in 4 stroke patients.
• Prolonged reversible ischemic neurological deficit (PRIND) and transient ischemic attack (TIA) rates were 0.8% and 1.6%, respectively.
• 30-day morbidity was 4.5%, with 0.8% mortality due to cerebral death.

Conclusions:

• Simultaneous TEA and cardiac surgery, including AVR, can be performed with acceptable neurological complication and mortality risks.
• Contralateral carotid artery occlusion is a significant predictor of increased neurological complications.
• Combined procedures offer reduced hospital costs compared to staged interventions.