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Published on: February 11, 2022
Heart surgery and simultaneous carotid endarterectomy - 10-years single-center experience
Stephen Gerfer1, Borko Ivanov1, Ihor Krasivskyi1
1Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany.
Insights
Simultaneous carotid endarterectomy (CEA) with heart surgery is safe for patients with coronary artery disease and carotid stenosis. This combined approach shows favorable early outcomes, including low rates of mortality and neurological events.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Vascular Surgery
Background:
- Coronary artery disease often coexists with carotid artery disease, increasing perioperative neurological risks.
- Guidelines suggest carotid endarterectomy (CEA) during myocardial revascularization for stroke/TIA history or significant stenosis.
- Controversy exists regarding the optimal timing and method of carotid revascularization in cardiac patients.
Purpose of the Study:
- To evaluate early outcomes of patients undergoing simultaneous coronary artery bypass grafting (CABG) or heart valve surgery with CEA.
- To assess the safety and feasibility of a combined surgical approach for patients with concurrent heart and carotid disease.
Main Methods:
- Retrospective analysis of 111 patients undergoing heart surgery (CABG or valve) with concomitant CEA between 2010-2020.
- Inclusion criteria: significant carotid stenosis requiring intervention alongside cardiac surgery.
Main Results:
- The cohort (77 ± 8 years) had high rates of hypertension (97%) and smoking history (61%).
- Mean internal carotid stenosis was 87%, with 13% bilateral disease.
- Thirty-day mortality was 6.3%; postoperative TIA occurred in 7.2% and disabling stroke in 4.5%.
Conclusions:
- Simultaneous heart surgery and CEA is a safe and feasible strategy for patients with coronary artery disease and significant carotid stenosis.
- The combined approach demonstrates acceptable early clinical and neurological outcomes.
Background:
Patients with coronary artery heart disease frequently suffer concomitant carotid vascular disease and are at high perioperative risk for neurological adverse events. Several concepts regarding the timing and modality of carotid revascularization are controversially discussed in patients with heart disease. Current guidelines recommendations on myocardial revascularization recommend a concomitant carotid endarterectomy (CEA) in patients with a history of stroke/transient ischemic attack (TIA) or 50-99% grade of the carotid stenosis. Our study aimed to analyze early outcome parameters of patients undergoing coronary artery bypass grafting (CABG), but also including concomitant heart valve surgery and simultaneous CEA.
Methods:
This study retrospectively analyzed a cohort of 111 patients from our institutional database undergoing heart surgery with CABG or heart-valve surgery between 2010 and 2020 with concomitant carotid surgery due to significant carotid stenosis.
Results:
Patients undergoing heart and simultaneous carotid surgery were 77 ± 8.0 years of age with a body mass index of 28 ± 1.7 kg/m2 and a mean EuroSCORE II of 6.5 ± 2.3. Most patients (61%) had a smoking history and arterial hypertension (97%). The preoperative mean grade of internal carotid stenosis was 87 ± 4.2%, 13% of patients suffered from internal carotid artery stenosis on both sites. In total, 4.5% of patients had previously undergone internal carotid artery intervention before and 6.3% had a history of stroke with a persistent neurologic disorder in 1.8%, 8.9% of cases had prior TIA. Thirty-day all-cause mortality was 6.3% and postoperative neurologic events occurred with 7.2% TIA and 4.5% of disabling stroke.
Conclusion:
Within the reported patient population of coronary artery heart disease and significant internal carotid stenosis, a one-time approach with CABG or heart-valve surgery and CEA is safe and feasible as justified by clinical and neurological postoperative outcomes.
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