Synchronous Carotid Endarterectomy and Anaortic Off-Pump Coronary Artery Bypass Surgery

Area of Science:

• Cardiovascular Surgery
• Neurology
• Vascular Surgery

Background:

• Debate exists on optimal surgical management for severe concomitant carotid and coronary artery disease.
• Anaortic off-pump coronary artery bypass (anOPCAB) reduces perioperative stroke risk by avoiding aortic manipulation and cardiopulmonary bypass.
• This study evaluates synchronous carotid endarterectomy (CEA) and anOPCAB outcomes.

Purpose of the Study:

• To assess the safety and efficacy of performing carotid endarterectomy (CEA) and anaortic off-pump coronary artery bypass (anOPCAB) synchronously.
• To determine the perioperative stroke rate and other adverse events in patients undergoing combined CEA and anOPCAB.
• To highlight the role of preoperative carotid-subclavian ultrasound screening in identifying suitable candidates.

Main Methods:

• Retrospective review of patients undergoing synchronous CEA and anOPCAB from 2009 to 2016.
• Primary endpoint: 30-day postoperative stroke.
• Secondary endpoints: 30-day transient ischemic attack (TIA), myocardial infarction, and mortality.

Main Results:

• 1,041 patients underwent anOPCAB with a 0.4% 30-day stroke rate.
• 39 patients with significant carotid disease underwent synchronous CEA-anOPCAB.
• The combined procedure resulted in a 2.63% stroke rate, 5.26% mortality, and 5.26% TIA rate within 30 days. No myocardial infarctions occurred. Acute kidney injury occurred in 5.26%.

Conclusions:

• Synchronous CEA and anOPCAB is a safe and effective strategy for patients with severe concomitant carotid and coronary artery disease.
• Preoperative carotid-subclavian ultrasound screening is crucial for identifying patients who can benefit from this combined approach.
• This combined surgical approach offers a viable option to manage complex cardiovascular and cerebrovascular conditions simultaneously.