Combined approach for internal carotid artery stenosis and cardiovascular disease in septuagenarians--a comparative study.
OBJECTIVE
The best surgical approach for concomitant carotid artery and cardiac disease remains controversial. Many studies proved the safety and efficiency of simultaneous surgery. We aimed to demonstrate the same benefits for patients > or = 70 years.


METHODS
We retrospectively evaluated 205 patients simultaneously operated upon between 1988 and 1998. Group A comprised patients < 70 years (n = 110), group B > or = 70 years, (n = 95). Risk factors, neurologic and cardiac history, angiographic findings, operative data, morbidity and mortality (30-day-postoperatively) were analysed. The mean age was 62 years in group A and 75 years in group B. All patients with symptomatic carotid artery disease, stenosis > 70% or ulcerative carotid disease had simultaneous surgery. Always, the carotid artery was addressed first.


RESULTS
Patients in group B had a higher prevalence of peripheral vascular disease (P = 0.0005), renal insufficiency (P = 0.0011) and COPD (P = 0.03). Urgent operation was indicated in 19% of group A patients vs. 37% in group B. In group A 70% were asymptomatic regarding the carotid vs. 48% in group B. Left ventricular dysfunction was present in 45% (group A) and 58% (group B). In the present study 4% in group A and 7% in group B suffered a perioperative myocardial infarction. Pathologic changes of the contralateral carotid were found in 42 vs. 57% (A vs. B). Mortality due to cardiac causes was 1 and 5%, respectively. The combination of persistent neurologic deficit and neurologic death occurred in 3% in group A (n = 3) and 5% in group B (n = 5). Postoperative neuro-cognitive dysfunction was more common in group B (35 vs. 16%; P = 0.01).


CONCLUSIONS
The incidence of persistent neurologic deficits and neurologic mortality in patients > or = 70 years is acceptable, and low in patients < 70 years. Preoperative risk factors are increasing with age and are related to the higher mortality in elderly patients. Due to our results we will conclude that the combined approach for carotid stenosis and cardiovascular disease is the method of choice in this high-risk population.
Busch
T
T
Department of Thoracic and Cardiovascular Surgery, Klinik und Poliklinik für Thorax-, Herz- und Gefässchirurgie, Georg-August-University, Goettingen, Germany. tbusch@gwdg.de
Sirbu
H
H
Aleksic
I
I
Kazmaier
S
S
Friedrich
M
M
Buhre
W
W
Dalichau
H
H
D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D006328:Cardiac Catheterization; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D016893:Carotid Stenosis / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016894:Endarterectomy, Carotid; D005240:Feasibility Studies; D005260:Female; D006331:Heart Diseases / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D017585:Ultrasonography, Doppler, Transcranial