Thorac Cardiovasc Surg 2012; 60(08): 508-516
DOI: 10.1055/s-0032-1311533
Original Cardiovascular/Society Paper
Georg Thieme Verlag KG Stuttgart · New York

Simultaneous Carotid Endarterectomy and Cardiac Surgery: Early Results of 386 Patients

Brigitte Gansera
1  Department of Cardiovascular Surgery, Clinic Bogenhausen, Munich, Germany
,
Fabian Schmidtler
1  Department of Cardiovascular Surgery, Clinic Bogenhausen, Munich, Germany
,
Josef Weingartner
1  Department of Cardiovascular Surgery, Clinic Bogenhausen, Munich, Germany
,
Theodor Kiask
1  Department of Cardiovascular Surgery, Clinic Bogenhausen, Munich, Germany
,
Felix Gundling
1  Department of Cardiovascular Surgery, Clinic Bogenhausen, Munich, Germany
,
Alexander Hapfelmeier
2  Institute for Medical Statistics and Epidemiology, Technical University Munich, Germany
,
Walter Eichinger
1  Department of Cardiovascular Surgery, Clinic Bogenhausen, Munich, Germany
› Author Affiliations
Further Information

Publication History

16 October 2011

30 January 2012

Publication Date:
12 July 2012 (online)

Abstract

Background The occurrence of severe carotid artery disease in more than 12% of patients requiring coronary artery bypass grafting (CABG) results in a discrepancy concerning best treatment for both diseases. We reviewed the early outcome of patients with CABG and/or valve replacement (VR) and simultaneous carotid endarterectomy (CEA).

Methods We retrospectively evaluated 386 patients after simultaneous operation between 7/1994 and 9/2010. Total 326 patients received isolated CABG, 56 CABG and/ or VR, 4 aortic surgery. Mean age was 68.3 years (range: 45 to 87). Male patients were 229. Severity of stenosis at operated side was 70 to 80% in 167, 80 to 99% in 219 patients. Total 164 patients showed bilateral carotid stenosis, 32 had contralateral occlusion. We analyzed risk factors, morbidity, incidence of neurological events, and 30-day mortality.

Results Perioperative stroke with hemiplegia occurred in 10 patients (2.6%). Three patients experienced PRIND, seven TIA. A 30-day mortality was 5.2%. Total 8 deaths were cardiac related, 10 due to extracardial reasons, and 2 patients developed a cerebral death.

Conclusions Simultaneous CEA and cardiac surgery can be performed with a low risk for neurological complications and acceptable mortality. Occlusion of contralateral carotid artery could be identified as an evident predictor for increased neurological complications.

Note

Presented at the 40th annual meeting of the German Society for Thoracic and Cardiovascular Surgery on February 13 to 16, 2011 in Stuttgart and at the 128th congress of the German Society for Surgery on May 3 to 6, 2011 in Munich, Germany.