title: Operative and 5-year outcomes of combined carotid and coronary revascularization: review of a large contemporary experience.
abstract: BACKGROUND
  Surgical treatment of concomitant coronary and carotid disease is controversial. Studies comparing staged versus combined coronary artery bypass grafting and carotid endarterectomy (CABG/CEA) report varying and often conflicting operative results. Also, few studies have investigated the long-term outcomes of combined surgery.
  
  
  METHODS
  We reviewed the operative outcome and 5-year survival results of 189 consecutive patients (69+/-9 years old, 66 [35%] female patients) who underwent combined CABG/CEA between 1994 and 1999. Survival follow-up was conducted in February 2001 and the incidence of late stroke, carotid surgery, and myocardial infarction was investigated in all surviving patients by mail survey. A phone interview was done by a surgeon of patients with late strokes or repeated CEA.
  
  
  RESULTS
  Operative death occurred in 5 of 189 patients (2.65%) 4 of which were in-hospital deaths. A total of 5 (2 permanent, 3 transient [2.65%]) perioperative strokes were documented in these patients, and 1 of the perioperative strokes patients died in the hospital. In all, 156 of 189 patients (82.5%) were alive at the time of the study and completed surveys were collected from 153 of 156 patients (98%). Of these 153 patients, 4 reported a late stroke (2.6%), 5 suffered a myocardial infarction (3.3%), and 16 (10.5%) underwent subsequent CEA (7 ipsilateral to original CEA). Angioplasty (3 of 153, 2.0%) and redo surgery (1 of 153, 0.66%) occurred infrequently. Median survival follow-up was 51 months (range 12 to 84), and the corresponding 5-year Kaplan-Meier survival was 79.4%. This survival was similar to that of age-matched isolated CABG patients (n = 532) with documented history of cerebrovascular disease but no surgical carotid lesions.
  
  
  CONCLUSIONS
  Our results suggest that combined CABG/ CEA is safe and may in fact reduce the risk of adverse outcomes in the intermediate term compared with age and risk-matched patients. We speculate the latter may be attributable to a cerebrovascular protective effect of CABG/CEA pending verification by randomized trials. An economic benefit of CABG/CEA may also be inferred from avoiding separate coronary and carotid operations and reduction in the high costs of perioperative stroke.
authors.affiliation: Department of Cardiovascular Surgery, St. Vincent Mercy Medical Center, Toledo, Ohio 43608, USA.
authors.forename: Anoar
authors.initials: A
authors.lastname: Zacharias
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Schwann
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Riordan
authors.forename: Paul M
authors.initials: PM
authors.lastname: Clark
authors.forename: Bernardo
authors.initials: B
authors.lastname: Martinez
authors.forename: Samuel J
authors.initials: SJ
authors.lastname: Durham
authors.forename: Milo
authors.initials: M
authors.lastname: Engoren
authors.forename: Robert H
authors.initials: RH
authors.lastname: Habib
mesh_terms: D000368:Aged; D016893:Carotid Stenosis / Q000401:mortality / Q000601:surgery*; D002423:Cause of Death; D003131:Combined Modality Therapy; D003327:Coronary Disease / Q000401:mortality / Q000601:surgery*; D016894:Endarterectomy, Carotid; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization; D011183:Postoperative Complications / Q000401:mortality*; D012189:Retrospective Studies; D016019:Survival Analysis; D015996:Survival Rate; D014481:United States