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Surgical outcome of simultaneous carotid and cardiac surgery
Masataka Yoda1, Mitsumasa Hata, Akira Sezai
1Department of Cardiovascular Surgery, The Cardiovascular Institute Hospital, 7-3-10 Roppongi, Minato-ku, Tokyo 106-0032, Japan.
Insights
Simultaneous carotid endarterectomy and cardiac surgery is safe, with low neurological complications. Heart-type fatty acid binding protein may predict these early neurological issues.
Area of Science:
- Cardiovascular Surgery
- Neurology
Background:
- The safety of combining carotid endarterectomy with cardiac procedures remains unclear.
- Carotid artery disease often coexists with conditions requiring cardiac surgery, such as coronary artery bypass grafting (CABG).
Purpose of the Study:
- To evaluate the short- and mid-term outcomes of patients undergoing simultaneous carotid endarterectomy and cardiac surgery.
- To assess the safety and efficacy of this combined surgical approach.
Main Methods:
- A retrospective review of 15 patients who underwent combined carotid endarterectomy and cardiac surgery (14 CABG, 1 aortic valve replacement).
- Carotid endarterectomy was performed under mild hypothermia with controlled hemodynamics and pulsatile perfusion.
- Patients with >75% carotid stenosis, with or without symptoms, were included.
Main Results:
- No early deaths were recorded.
- A low rate of early neurological complications (6.7%) was observed.
- Elevated heart-type fatty acid binding protein levels correlated with postoperative neurological complications.
Conclusions:
- Carotid endarterectomy can be safely performed concurrently with cardiac surgery.
- Heart-type fatty acid binding protein may serve as a useful biomarker for predicting early neurological complications after these combined procedures.
Purpose:
The surgical outcome of a simultaneous carotid endarterectomy and cardiac surgery has not been clarified. This study retrospectively reviewed short- and mid-term outcomes after a carotid endarterectomy combined with valvular surgery or coronary artery bypass grafting (CABG).
Methods:
Fifteen patients (12 males and 3 females, mean age 68.9 ± 6.7, range 59-86 years) underwent a carotid endarterectomy combined with cardiac surgery. The main indication for carotid endarterectomy was more than 75% carotid stenosis with or without cerebral ischemic symptom. Eight patients had a history of stroke or transient ischemic attack. Endarterectomy was performed under mild hypothermia and controlled hemodynamics with pulsatile perfusion with cardiopulmonary bypass in all cases. Concomitant cardiac procedures were aortic valve replacement in 1 patient and CABG in 14 patients.
Results:
There was no early death. Early neurological complications occurred in only 1 patient (6.7%). The ratio of heart-type fatty acid binding protein increased significantly in those that suffered postoperative neurological complications. One patient died 6 months after the operation due to pneumonia. There was no myocardial infarction, and no events were observed in the late postoperative periods.
Conclusions:
Carotid endarterectomy can be safely performed in combination with cardiac surgery. Furthermore, the heat-type fatty acid binding protein levels might be useful for predicting early neurological complications.
