Results of synchronous carotid endarterectomy and cardiac surgery: A single centre experience

Objectives: The best approach to the management of concomitant carotid and coronary artery and/or aortic valve disease remains controversial in the literature. This analysis reports the outcome of the combined surgery in this particular patient cohort.

Methods: Fifty-nine consecutive patients underwent combined carotid artery endarterectomy and coronary artery bypass grafting (CABG) and/or aortic valve replacement (AVR) in a period of 68 months until August 2012. Mean age of patients was 71.8 years, 19 were female and 40 male. Indication for operation was bilateral significant carotid stenosis, unilateral symptomatic or high-grade carotid stenosis concomitant with coronary artery disease with unstable angina or symptomatic aortic valve stenosis.

Thirty-nine patients underwent carotid thrombendarterectomy with patchplasty and 20 an endarterectomy. 47 coronary artery bypass grafting, 6 CABG with aortic valve replacement and 6 isolated aortic valve replacements were performed in the same operation.

The preoperative cerebrovascular status was as following: stage IA in 25, stage IB in22, stage IIB in 8 and stage IV in 4 patients.

Results: The 30 days mortality rate was 3.4%. One patient (Stage IIB/CABG+AVR) died at postoperative day 5 caused by pneumonia and another (Stage IB/CABG) in postoperative day 30 at multiorgan failure.

No postoperative stroke or TIA was observed in this patient cohort.

Conclusion: The combined approach for carotid artery endarterectomy together with CABG or AVR has favourable outcome in this selected patient group. A randomized trial needs to be performed to determine the optimal management of patients with concomitant carotid, coronary artery or aortic valve disease.