Cardiac events after combined surgery for coronary and carotid artery disease

• Published in: European journal of cardio-thoracic surgery Vol. 11; no. 6; pp. 1074 - 1079
• Main Authors: PERIC, M, HUSKIC, R, NEZIC, D, NASTASIC, S, POPOVIC, Z, RADEVIC, B, POPOVIC, A. D, BOJIC, M
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Amsterdam Elsevier Science B.V 01-06-1997; Elsevier Science
• Subjects: Aged; Biological and medical sciences; Cardiology. Vascular system; Carotid Stenosis - complications; Carotid Stenosis - surgery; Coronary Artery Bypass; Coronary Artery Disease - complications; Coronary Artery Disease - surgery; Coronary heart disease; Endarterectomy, Carotid; Female; Heart; Humans; Male; Medical sciences; Middle Aged; Postoperative Complications; Prognosis; Proportional Hazards Models; Human; Coronary artery; Stenosis; Cardiovascular disease; Coronary heart disease; Result; Arterial disease; Concomitant disease; Treatment; Combined surgery; Aortocoronary; Bypass; Surgery; Carotid; Complication; Endarteriectomy
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/S1010-7940(97)01212-8

OBJECTIVE: To evaluate serious cardiac events after combined (eithersingle or two stage) coronary artery surgery (CAS) and carotidendarterectomy (CEA) for concomitant coronary and carotid artery disease.METHODS: We have analyzed our 15 year experience (January 1981- September1996) with 201 consecutive patients operated on using both approaches.Group A consisted of 48 patients with the single-stage procedure, while ingroup B (153 patients), two stage procedure was carried out, either ascarotid endarterectomy (CEA), followed by coronary artery bypass surgery(CAS) (group B1- 103 patients), or as CAS followed by CEA (group B2- 50patients). Five patients from B1 group died after the CEA procedure, butwere included, despite the fact they never reached the second stage. Leftmain coronary artery disease was found in 41 patients (20.4%), poor leftventricular function in 49 (24.4%) previous MI in 133 (66.2%), while 136(67.7%) were in NYHA functional class III or IV. Bilateral carotidinvolvement was present in 61 patients (30.3%). Unstable angina was moreprevalent in groups A and B2 (P < 0.0001). NYHA class III/IV in group A(versus B1, P = 0.001 and versus B2, P = 0.02), low ejection fraction ingroups A and B2 (P < 0.0001), bilateral carotid stenosis in group B1(versus A, P = 0.003 and versus B2, P < 0.0001), and ulcerated plaque ingroup B1 (P < 0.0001). These differences dictated the surgical strategy,which resulted in different protocols for clinical and operativemanagement. RESULTS: Early mortality for the entire group was 5.5% (11/201)6.2% in group A, 7.8% in group B1 and 0% in group B2, respectively; (P >0.05). Serious morbidity occurred in 7.5% of patients (8.3% in group A,7.8% in group B1 and 6% in group B2, respectively; P > 0.05). Univariateanalysis revealed only bilateral carotid stenosis to influence earlyoutcome (P = 0.04). CONCLUSION: Patients with concomitant coronary andcarotid artery disease have relatively good immediate operative results,providing all existing lesions are corrected. Despite it did not reach thestatistical significance, cardiac events were less frequent in groups A andB2 indicating possible protective effect of prior CAS in patients withconcomitant disease.