Early Results of Combined and Staged Coronary Bypass and Carotid Endarterectomy in Advanced Age Patients in Single Centre

Abstract

Aim:In present study, we aimed to compare the staged and combined surgery in patients with severe carotid stenosis and coronary atherosclerosis and detect the factors affecting mortality and morbidity.Material and method: Between 2004 and 2008, 120 patients with predominant ischemic heart disease were enrolled to study. Patients were divided into three groups on basis surgery procedure. Group 1 (n=40) includeed patients had coronary artery disease without carotid disease underwent coronary artery by-pass graft (CABG) operation. Group 2 (n=40): included patients underwent combined surgery procedure including CABG and carotid endarterectomy (CEA). Patients underwent staged CABG and CEA were enrolled to Group 3 (n=40). All patients were in advanced aged and were had the same risk factors atributable atherosclerosisResults:Mean age of the patients in all groups were 68±6, 69±3, 71±2 respectively, and 83% were male. Eight patients died in all groups at follow-up(seven in group 2 and 3, and one in group 1) and the difference between both groups was statistically significant (p<0.001). The follow-up period in the intensive care unit, and hospitalization period were not statistically different between CABG group and combined CEA plus CABG group.Conclusion:We think that the results of staged or combined CABG plus CEA surgery are satisfactory in patients with severe carotid disease and advanced coronary artery disease. However, the mortality and morbidity in both procedures are higher than those of alone.

Twenty-Four Hour Staged Carotid Endarterectomy Followed by Off-Pump Coronary Bypass Grafting for Patients With Concomitant Carotid and Coronary Disease

“…Other reports have found higher overall complications and higher hospital cost from staged as opposed to synchronous interventions [24], whereas some studies found no difference in length of stay or stroke rate between staged or synchronous procedures [12]. Our study is consistent with that by Ieym and colleagues [12] with an average length of stay of 7.5 days. We believe that staging CABG within 24 hours of CEA can minimize the risk of combined procedures by limiting prolonged anesthesia time and associated complications, as well as decreasing MI after CEA.…”

“…We believe that staging CABG within 24 hours of CEA can minimize the risk of combined procedures by limiting prolonged anesthesia time and associated complications, as well as decreasing MI after CEA. Cardiac events are the number one cause of death after CEA with 1.5% to 7.3% of patients having a perioperative MI [12,27]. In our study, 1 patient had an MI post-CEA prior to undergoing CABG.…”

“…This compares favorably with the published endpoint incidence (MI, stroke, and death) of 9.5% to 11.5% for synchronous CEA and CABG, 3.6% for synchronous CEA and offpump CABG, 10.2% for staged CEA followed by CABG and 5.0% for staged CABG followed by CEA [26]. Other reports have found higher overall complications and higher hospital cost from staged as opposed to synchronous interventions [24], whereas some studies found no difference in length of stay or stroke rate between staged or synchronous procedures [12]. Our study is consistent with that by Ieym and colleagues [12] with an average length of stay of 7.5 days.…”

“…Thus preoperative medical optimization is vital [29]. Nonetheless, of patients undergoing a CABG with 50% to 99% carotid artery occlusion, 7.4% to 10.9% of patients will have a cerebrovascular event [12,25]. Hence, surgical optimization is also important.…”

“…Nevertheless, completing carotid surgery several days to weeks before CABG leaves the patient at risk for postoperative MI, the highest incidence of perioperative MI occurring on postoperative day 3 [11]. Many studies reporting staged results do not report the length of time between operations, while those that do range from 2 to 32 days [5,10,[12][13][14][15]. One study compared early and late outcomes with 3 approaches (synchronous CEA and open heart surgery, staged CEA and open heart surgery and staged carotid artery stenting and open heart surgery), including interstage events as a risk factor for outcomes after open heart surgery [16].…”