title: The safety of combined cardiac and vascular operations: how much is too much?
abstract: OBJECTIVE
  The purpose of this study was to identify factors correlating with a poor outcome following combined cardiac and vascular procedures.
  
  
  METHODS
  We reviewed 45 consecutive patients undergoing combined cardiac and vascular operations. These included cardiac/CEA (n=27), cardiac/AAA (n=13), cardiac/AAA/one other vascular reconstruction (n=4), and cardiac/renal artery bypass (n=1). Group I included all patients with no morbidity or mortality (n=41) and Group II included patients who died or suffered significant morbidity (stroke, renal failure) (n=4).
  
  
  RESULTS
  Overall mortality was 4.4% (2/45). These two patients underwent cardiac surgery combined with two additional vascular procedures (cardiac/AAA/other). In patients undergoing cardiac/CEA or cardiac/AAA, there were no deaths and one stroke (contralateral to CEA). Group II had significantly decreased ejection fraction (39%+/-6% vs 52%+/-1%) and an increased number of procedures (2.75 vs 2.04).
  
  
  CONCLUSIONS
  Combined cardiac surgery and vascular reconstruction can be performed safely. However, multiple vascular reconstructions or the presence of decreased ejection fraction increased operative risk.
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia Health Sciences Center, Charlottesville, VA 22908, USA. jjg5d@virginia.edu
authors.forename: J J
authors.initials: JJ
authors.lastname: Gangemi
authors.forename: I L
authors.initials: IL
authors.lastname: Kron
authors.forename: S D
authors.initials: SD
authors.lastname: Ross
authors.forename: C G
authors.initials: CG
authors.lastname: Tribble
authors.forename: J A
authors.initials: JA
authors.lastname: Kern
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery; D006348:Cardiac Surgical Procedures; D003131:Combined Modality Therapy; D001026:Coronary Artery Bypass; D016894:Endarterectomy, Carotid; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000401:mortality; D012078:Renal Artery Obstruction / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D014656:Vascular Surgical Procedures