Combined Surgery for cardiac and carotid disease: management and results of a rational approach.
OBJECTIVE
The aim of the present study was to apply a rational plan for simultaneous cardiac and carotid surgery in high-risk patients.


METHODS
A consecutive series of 89 patients with coexisting severe cardiac and carotid disease were operated on during a 5-year period with routinary carotid shunting, moderate hypothermia and balanced anaesthesia. The combined surgical procedures were coronary artery by-pass grafts (CABG) + carotid endarterectomy (CEA) in 81 patients, CABG + CEA + aortic valve replacement (AVR) in four patients, and four cases of CEA + AVR. RESSULTS: Two deaths (2%), three acute myocardial infarctions (3%) and one (1%) major stroke occurred in five patients during the perioperative (30 days) period for a combined rate of death and/or disabling stroke of 3%. There were five reversible neurological deficits. Carotid and aortic mean clamping times were 9 and 60 min respectively. Patients were discharged after a mean length of stay in Intensive Care Unit (ICU) of 131 h and 7 days of hospitalisation post-ICU.


CONCLUSIONS
Based on our results, combined interventions of CEA and CABG can be performed with an acceptable morbidity and mortality when severe carotid stenosis is associated with advanced, symptomatic cardiac disease. The management of these patients needs careful and appropriate pre-intra and post-operative assessment and timing aimed to reduce the ischaemic injuries, both cardiac and cerebral, especially during CBP time.
Snider
F
F
Institute of Surgical Semeiothic, Catholic University of the Sacred Heart, Rome, Italy.
Rossi
M
M
Manni
R
R
Modugno
P
P
Glieca
F
F
Scapigliati
A
A
Luciani
N
N
Vincenzoni
C
C
Schiavello
R
R
D000368:Aged; D000369:Aged, 80 and over; D016893:Carotid Stenosis / Q000150:complications / Q000401:mortality / Q000601:surgery*; D003131:Combined Modality Therapy; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000150:complications / Q000401:mortality / Q000601:surgery*; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality; D012307:Risk Factors; D020521:Stroke / Q000401:mortality; D015996:Survival Rate