Effect of hypothermia in patients undergoing simultaneous carotid endarterectomy and coronary artery bypass graft surgery : cardiovascular topic

Abstract

SummaryPurposeWe sought to determine whether hypothermia provided any benefit in patients undergoing simultaneous coronary artery bypass graft surgery (CABG) and carotid endarterectomy (CEA) using one of two different surgical strategies.MethodsGroup 1 patients (n = 34, 88.2% male, mean age 65.94 ± 6.67 years) underwent CEA under moderate hypothermia before cross clamping the aorta, whereas group 2 patients (n = 23, 69.6% male, mean age 65.78 ± 9.29 years) underwent CEA under normothermic conditions before initiating cardiopulmonary bypass (CPB). Primary outcome of interest was the occurrence of any new neurological event.ResultsThe two groups were similar in terms of baseline characteristics. Permanent impairment occurred in one patient (2.9%) in group 1. One patient from each group (2.9 and 4.3%) had transient neurological events and they recovered completely on the sixth and 11th postoperative days, respectively. Overall, there was no statistically significant difference between the two groups with regard to occurrence of early neurological outcomes (n = 2, 5.8% vs n = 1, 4.3%, p = 0.12).ConclusionsThis study could not provide evidence regarding benefit of hypothermia in simultaneous operations for carotid and coronary artery disease because of the low occurrence rate of adverse outcomes. The single-stage operation is safe and completion of the CEA before CPB may be considered when short duration of CPB is required.

Clinically induced hypothermia with cardiopulmonary support in a high-risk patient undergoing carotid endarterectomy

“…Her asymptomatic coronary disease was considered stable with conservative treatment. Simultaneous treatment appeared of low benefit, 8 even with hypothermia, 9 which supported this decision. After rehabilitation, she remained asymptomatic and refused coronary revascularization.…”

Early Results of Surgical Simultaneous Therapy for Significant Carotid Artery Stenosis and Heart Disease

“…7 Although Ozen et al found no clear evidence of hypothermia in CEA, we used hypothermic ECC because of its beneficial effects in cardiac surgical procedures. 8,9 From our point of view, in case of CS beyond 70% on one side, the simultaneous repair together with coronary bypass is indicated 10 because of an beneficial outcome, even in case of so-called asymptomatic CS. 11 Gansera et al reported occurrence of perioperative symptoms of stroke with hemiplegia in 10 (2.6%) patients.…”

Coronary Artery Bypass Surgery

“…In both approaches, carotid endarterectomy is performed primarily to prevent stroke. When a concomitant procedure is performed, carotid endarterectomy can be performed during hypothermic CPB before CABG, which provides additional brain protection [48]. Neither strategy has not been proved to be superior to another, and an individualized approach is most appropriate.…”