<b>Simultaneous Carotid Endarterectomy and Coronary Revascularization is Safe Using Either On-Pump or Off-Pump Technique</b>

Abstract

SUMMARYThe appropriate surgical strategy for patients with combined carotid and coronary artery disease remains controversial. We retrospectively compared our surgical results for 2 types of approaches in this disorder.The records of 76 patients consecutively operated on for carotid and coronary artery disease between August 1993 and October 2004 were reviewed. There were 18 males (66.6%) and 9 females (33.3%) in group I. Group II consisted of 35 males (71.4%) and 14 females (28.5%). The patients were divided into two groups: patients with combined off-pump coronary artery bypass and carotid endarterectomy (group I, n = 27), and those with one-stage on-pump coronary artery bypass and carotid endarterectomy (group II, n = 49). Surgical mortality and morbidity and late outcome were compared among the two groups.The average number of grafts was 1.2 ± 0.4, with the average operative time of 3.3 ± 0.3 hours in group I, and 2.3 ± 0.5 grafts with operative time of 4.6 ± 0.4 hours in group II (P < 0.001 and P < 0.001, respectively). There was 1 death (3.7%) in group I and 2 deaths (4.8%) in group II (P = 0.937). No patient from either group I or group II had postoperative stroke. Mean hospital stay was 7.4 ± 1.9 days in group I and 11.3 ± 1.7 days in group II (P < 0.001). At a mean follow-up of 5.5 ± 3.3 years in group I, 1 patient had contralateral carotid endarterectomy (3.7%). Group II had a mean follow-up of 5.2 ± 3.0 years and contralateral carotid endarterectomy was performed in 1 patient (2.0%). There were no late strokes or deaths in either group.Combined coronary artery bypass grafting and carotid endarterectomy using 2 different types of technique is a safe and effective procedure in patients with significant concomitant monolateral carotid and coronary artery disease. (Int Heart J 2005; 46: 783-793)

Comparison of Early Outcomes with Three Approaches for Combined Coronary Revascularization and Carotid Endarterectomy

“…In our clinic, off-pump CABG has been in practice since 1993, and is mainly preferred for single or double vessel revascularization. A previous study by Eren et al [25] from our center reported no stroke and 3.7% mortality for patients who had CEA and simultaneous off-pump CABG. In the literature, reported rate of mortality is between 0-4.5% and rate of stroke is between 0-3.1% for combined CEA and off-pump CABG [16,21-24] .…”

Treatment Strategy for Combined Carotid Artery Stenosis and Coronary Artery Disease: Staged or Simultaneous Surgical Procedure?

“…Totally 41,901 patients undergoing simultaneous or staged carotid and coronary procedures were collected from 53 reports (Evagelopoulos et al 2000;Snider et al 2000;Minami et al 2000;Gaudino et al 2001;Hamulu et al 2001;Youssuf et al 2001;Estes et al 2001;Farooq et al 2001;Bonacchi et al 2002;Bonardelli et al 2002;Antunes et al 2002;Zacharias et al 2002;Meharwal et al 2002;Roddy et al 2002;Char et al 2002;Beauford et al 2003;Brown et al 2003;Vitali et al 2003;Ricotta et al 2003;Srimahachota et al 2004;Mishra et al 2004;Ricotta et al 2005;Ziada et al 2005;Cinar et al 2005;Eren et al 2005;Chiappini et al 2005;Akins et al 2005;Nwakanma et al 2006;Inciura and Benetis 2006;Kolh et al 2006;Byrne et al 2006;Cywinski et al 2006;Kovacic et al 2006;Mendiz et al 2006;Randall et al 2006;Chiariello et al 2006;Hertzer and Mascha 2006;Madi-Jebara et al 2006;Kougias et al 2007;Dubinsky and Lai 2007;…”

Surgical outcome of simultaneous carotid and cardiac surgery

“…However, even large cohort reports concluded that equally good results for cardiac and neurological events can be reproduced using either cardiopulmonary bypass or off-pump techniques for coronary artery surgery, and conventional carotid endarterectomy or CAS for carotid artery surgery. [24][25][26][27] At present, protein S100B, neuron-specifi c enolase (NSE), myelin basic protein, and glial fi brillary acidic protein are being evaluated as marker proteins in cerebrospinal fl uid and/or blood for detection of brain injury in patients with stroke or brain injury. 28 H-FABP has been used as a biochemical plasma marker for myocardial infarction, neurological disorders, or brain injury.…”