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Simultaneous hybrid carotid stenting and coronary bypass surgery versus concomitant open carotid and coronary bypass
Slobodan Mićović1, Srdjan Bošković2, Dragan Sagić3
1Department of Cardiac Surgery, Dedinje Cardiovascular Institute, University School of Medicine, Belgrade, Serbia boban.mic@gmail.com micko2006@yahoo.com.
Insights
The hybrid procedure of carotid artery stenting (CAS) and coronary bypass surgery may be a safe alternative to open surgery, with no significant difference in early outcomes. Further research is needed to confirm its value in reducing stroke and mortality risks.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Vascular Surgery
Background:
- Concomitant carotid and cardiac surgery presents significant perioperative risks.
- The efficacy of hybrid procedures combining carotid artery stenting (CAS) and coronary bypass grafting (CABG) remains unclear.
Purpose of the Study:
- To compare early outcomes of simultaneous hybrid CAS and CABG versus open concomitant carotid and coronary bypass surgery.
- To assess the safety and effectiveness of the hybrid approach in reducing stroke and other complications.
Main Methods:
- A study involving 20 patients divided into two groups: Group 1 (10 patients) with hybrid CAS and CABG, and Group 2 (10 patients) with open concomitant surgery.
- Comparison of preoperative, intraoperative, and postoperative variables, with the primary endpoint being the combined incidence of stroke and death within 30 days or during hospitalization.
Main Results:
- Groups were comparable in preoperative characteristics, including age, comorbidities, and left ventricular ejection fraction.
- Extracorporeal circulation time was significantly shorter in the hybrid group (Group 1).
- The primary endpoint (stroke and death) occurred in 20% of the open surgery group (Group 2) but not in the hybrid group, though this difference was not statistically significant.
Conclusions:
- The hybrid procedure of CAS and coronary surgery may represent a viable therapeutic option.
- While preliminary results are promising, larger studies are required to definitively establish the value of the hybrid approach.
Objectives:
Concomitant carotid and cardiac surgery carries an increased perioperative morbidity and mortality risk. Whether the hybrid procedure of carotid artery stenting (CAS) and coronary bypass surgery decreases the risk of stroke and other complications is still unknown. The aim of this study was to assess early outcomes after simultaneous hybrid CAS and coronary bypass grafting versus open concomitant carotid and coronary bypass surgery.
Methods:
We included 20 patients in this study. According to the protocol, all the patients were divided into two groups: Group 1 (10 patients) with hybrid CAS and coronary bypass surgery and Group 2 (10 patients) with concomitant carotid and coronary surgery. Different preoperative, intraoperative and postoperative variables were compared. The primary end point was combined incidence of stroke and death 30 days after surgery or during initial hospitalization. The secondary end points were myocardial infarction, atrial fibrillation, blood loss and need for blood transfusion and duration of intensive care unit and hospital stay.
Results:
Groups 1 and 2 were similar in preoperative characteristics including age (65.3 ± 6.8 vs 70.7 ± 7.0, P = 0.191) New York Heart Association class (2.3 ± 0.5 vs 1.8 ± 0.7, P = 0.218), EuroSCORE (2.8 ± 2.0 vs 3.6 ± 2.3, P = 0.547), the degree of carotid stenosis (79 ± 12 vs 87 ± 13%, P = 0.224) and average left ventricular ejection fraction (44.3 ± 12.4 vs 43.4 ± 13.3%, P = 0.896). Also, the groups did not differ in intraoperative variables with an exception of extracorporeal circulation time (65.7 ± 14.1 vs 90.0 + 17.4 min, P = 0.023), which was significantly shorter in Group 1. Although rare, and without significant difference, primary end point occurred only in Group 2 (1 stroke and 1 death, 20%). There was no difference in the duration of mechanical ventilation, need for transfusion and duration of intensive care unit and hospital stay between the two groups.
Conclusions:
Although limited by a small sample size, our results show that the hybrid procedure of carotid stenting and coronary surgery might be a good therapeutic option but further extended studies are needed to assess its real value.
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