title: Combined carotid endarterectomy and coronary artery bypass: immediate and long-term results.
abstract: Data from 213 cases of simultaneous carotid endarterectomy and coronary artery bypass grafting (CEN/CABG) were analyzed (1980-1996). There were 154 males (72.3%), and 59 females (27.7%), (mean age: 65. 6 years, range: 42-83). One hundred and thirty-two patients (62.0%) had angina, 58 (37.2%) had myocardial infarction, and 23 (10.8%) had congestive heart failure. Symptomatic cerebrovascular disease was present in 89 patients (41.7%). One hundred and twenty-two patients (57.2%) had three-vessel coronary artery disease, 41 (19.2%) had left main disease, and 27 (12.6%) had a low ejection fraction (ejection fraction </=30%). Significant (>/=75% diameter reduction) stenosis was present in 168 (78.8%) of the operated carotid arteries. The contralateral internal carotid artery was severely stenosed or occluded in 35 patients (16.4%). The hospital mortality rate was 5. 6% (12 patients). The cause of death was cardiac in ten patients (4. 6%), and neurologic in two (1%). Eleven patients (5.1%) developed a stroke postoperatively; eight strokes were ipsilateral to the operated artery, and six were permanent. Myocardial infarction occurred in five patients (2.3%). Independent predictors of early mortality were age >62 years, hypertension, and postoperative stroke (p < 0.05). Male sex was the only independent predictor of neurologic morbidity (p < 0.05). Late follow-up data were obtained for 163 (81.0%) patients (mean: 54.8 months, range: 1-168). Four (9. 3%) out of the 43 late deaths were attributed to strokes. There were three (1.8%) late ipsilateral strokes, and five (3.1%) contralateral strokes. The 5- and 10-year survival probabilities were 75 +/- 4%, and 52 +/- 6.9%. The freedom from late ipsilateral neurologic morbidity at 5 and 10 years were 97 +/- 1.7% and 90 +/- 4.0%, respectively. Taken together, the results indicate that combined carotid endarterectomy and coronary artery bypass grafting can be performed safely in this high-risk group of patients. Excellent long-term freedom from stroke can be expected.
authors.affiliation: Department of Cardiovascular Surgery, Baylor College of Medicine, Houston, TX.
authors.forename: K A
authors.initials: KA
authors.lastname: Plestis
authors.forename: S
authors.initials: S
authors.lastname: Ke
authors.forename: Z D
authors.initials: ZD
authors.lastname: Jiang
authors.forename: J F
authors.initials: JF
authors.lastname: Howell
mesh_terms: D000368:Aged; D016893:Carotid Stenosis / Q000601:surgery; D002561:Cerebrovascular Disorders / Q000453:epidemiology* / Q000517:prevention & control; D001026:Coronary Artery Bypass / Q000401:mortality* / Q000706:statistics & numerical data; D003327:Coronary Disease / Q000601:surgery; D016894:Endarterectomy, Carotid / Q000401:mortality* / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors