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Simultaneous carotid endarterectomy and coronary bypass: perioperative risk and long-term survival
W C Mackey1, K Khabbaz, R Bojar
1Department of Surgery, New England Medical Center, Tufts University School of Medicine, Boston, MA 02111, USA.
Insights
Simultaneous coronary bypass-carotid endarterectomy (CABG-CEA) shows higher perioperative risks than carotid endarterectomy (CEA) alone. Long-term survival is similar, but staged procedures may reduce risks.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Neurosurgery
Background:
- Coronary artery disease (CAD) and carotid artery disease (CAD) often coexist.
- Patients with both conditions may require surgical intervention.
- Assessing the safety and efficacy of combined procedures is crucial.
Purpose of the Study:
- To evaluate the outcomes of simultaneous coronary artery bypass grafting-carotid endarterectomy (CABG-CEA).
- To compare CABG-CEA outcomes with carotid endarterectomy (CEA) alone in high-risk cardiac patients.
- To identify factors influencing perioperative risk in combined procedures.
Main Methods:
- Retrospective review of 100 patients undergoing CABG-CEA and 114 patients undergoing CEA alone.
- Patients in the CABG-CEA group were at high cardiac risk.
- Comparison of perioperative mortality, stroke morbidity, and long-term survival.
Main Results:
- The CABG-CEA group had higher rates of symptomatic carotid disease and contralateral occlusion.
- Patients in the CABG-CEA group were older and more frequently smokers.
- Perioperative mortality (8% vs 1.8%) and stroke morbidity (9% vs 2.6%) were significantly higher in the CABG-CEA group.
Conclusions:
- Patient selection significantly impacts perioperative risk for CABG-CEA.
- Differences in long-term survival were primarily due to perioperative morbidity and mortality.
- Prospective studies investigating staged CEA and CABG are warranted to mitigate risks.
Purpose:
The purpose of this article is to examine the outcome of simultaneous coronary bypass-carotid endarterectomy (CABG-CEA) and to compare it with the outcome of endarterectomy alone (CEA alone) in patients at high cardiac risk.
Methods:
A retrospective review of the records and follow-up data for 100 consecutive patients who had undergone CABG-CEA and were at high risk and 114 patients who had undergone CEA, had overt coronary artery disease (angina, previous infarct, or ischemic electrocardiographic abnormalities), but had not undergone CABG was carried out.
Results:
Our CABG-CEA group had a high incidence of symptomatic carotid disease (57%) and contralateral occlusion (28%) when compared with patients in other reports. Patients in the CABG-CEA group were older (67.9 +/- 8.3 years vs 63.6 +/- 15.7 years, p = 0.01) and more often smokers (81% vs 52.6%, p = 0.01) than patients in the CEA alone group. Perioperative mortality was 8% for the CEA-CABG group and for 1.8% for the CEA alone group (p = 0.035). Perioperative stroke morbidity was 9% for the CEA-CABG group and 2.6% for the CEA alone group (p = 0.05). Life table survival at 1,3, and 5 years was 90%, 82%, and 73% versus 96%, 84%, and 76% for the CABG-CEA and CEA alone groups, respectively (p = 0.30).
Conclusions:
Selection criteria for CABG-CEA greatly influence perioperative risk. Despite the greater age and more advanced coronary artery disease in the CABG-CEA group, long-term outcome differences are accounted for entirely by differences in perioperative morbidity and mortality. Prospective trials of strategies such as staged CEA and CABG to reduce perioperative risk are needed.