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Published on: May 9, 2013
Major Adverse Cardiac and Cerebrovascular Events in Patients Undergoing Simultaneous Heart Surgery and Carotid
Stephen Gerfer1, Walid Bennour1, Alina Chigri1
1Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, 50937 Cologne, Germany.
Insights
Patients undergoing simultaneous carotid and heart surgery face risks. Prior transient ischemic attack and kidney disease predict worse outcomes, including cardiovascular complications.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Nephrology
Background:
- Patients with simultaneous internal carotid artery stenosis and heart disease are high-risk for severe cerebrovascular or cardiovascular events during surgery.
- Current strategies for carotid revascularization in these patients are debated, necessitating more outcome data.
- Understanding predictors of adverse events is crucial for optimizing treatment in this complex patient group.
Purpose of the Study:
- To identify predictors of major adverse cardiac and cerebrovascular events (MACCE) in patients undergoing combined heart and carotid surgery.
- To analyze the relationship between preoperative and intraoperative factors and postoperative outcomes.
- To elucidate the drivers of severe events in this high-risk surgical population.
Main Methods:
- Retrospective analysis of 111 patients undergoing heart surgery (coronary artery bypass grafting or valve surgery) with concomitant carotid surgery.
- Patients were stratified into groups based on the occurrence of 30-day MACCE, including mortality, myocardial infarction, stroke, and transient ischemic attack.
- Preoperative and intraoperative characteristics were compared between groups.
Main Results:
- Preoperative factors like chronic obstructive pulmonary disease, chronic kidney disease, unstable angina, and prior transient ischemic attack were more prevalent in the MACCE group.
- Intraoperative findings included higher rates of intra-aortic balloon pump use in the MACCE cohort.
- MACCE patients experienced significantly more postoperative bleeding, re-thoracotomy, cardiopulmonary resuscitation, new-onset dialysis, and prolonged ICU stays.
Conclusions:
- Preoperative transient ischemic attack and kidney disease are associated with worse outcomes after simultaneous carotid endarterectomy and heart surgery.
- Severe postoperative events are not solely neurological but also linked to cardiovascular complications.
- These findings highlight the multifactorial nature of adverse events in this patient population.
Background:
Patients with simultaneous relevant internal carotid artery stenosis and coronary artery heart or valve disease represent a high-risk collective with respect to cerebral or cardiovascular severe events when undergoing surgery. There exist several concepts regarding the timing and modality of carotid revascularization, which are controversially discussed in patients with heart disease. More data regarding outcome predictors and measures are needed to gain a better understanding of the best treatment option of the discussed patient collective.
Methods:
This single-center study retrospectively analyzed n = 111 patients undergoing heart surgery with coronary artery bypass grafting or heart-valve surgery and concomitant carotid surgery due to significant internal carotid artery stenosis. In order to do so, patients were divided into two groups with respect to postoperative major adverse cardiac and cerebrovascular events (MACCE) with thirty-day all-cause mortality, valve related mortality, myocardial infarction, stroke and transitory ischemic attack.
Results:
Preoperative patient's characteristic in the no-MACCE and MACCE group were mainly balanced, other than higher rates of chronic obstructive pulmonary disease, chronic kidney disease, instable angina pectoris and prior transitory ischemic attack in the MACCE cohort. The analysis of intraoperative characteristics revealed a higher number of intra-aortic balloon pump implantation, which is in line for a higher number of postoperative supports. Besides MACCE, patients suffered significantly more often from postoperative bleeding events and re-thoracotomy, cardiopulmonary reanimation, new onset postoperative dialysis and prolonged intensive care unit stay related complications.
Conclusions:
Within the reported patient population suffering from MACCE after a simultaneous carotid endarterectomy and heart surgery, a preoperative history of transitory ischemic attack and kidney disease might account for worse outcomes, as severe events were not only neurologically driven but also associated with postoperative cardiovascular complications following heart surgical procedures.
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