title: Simultaneous carotid endarterectomy and cardiac surgery--additional risk factor or safety procedure?
abstract: BACKGROUND
  The occurrence of severe carotid artery disease in more than 12 % of patients requiring CABG results in a discrepancy concerning the best treatment for both diseases. We reviewed the early outcome of patients with CABG and/or valve replacement and simultaneous carotid endarterectomy (CEA).
  
  
  METHODS
  We evaluated retrospectively 244 patients operated simultaneously between 7/94 and 10/2001. 209 patients received CABG; 35 patients CABG and/or valve replacement. Mean age was 68 years. 188 patients were male. We analyzed risk factors, morbidity, incidence of neurological complications and 30 day mortality.
  
  
  RESULTS
  Perioperative stroke with hemiplegia occurred in 3.3 % (8 patients). 4 of these patients showed contralateral carotid artery occlusion, 2 contralateral severe stenosis. 2 patients (0.8 %) experienced prolonged reversible ischemic neurological deficit (PRIND), 4 patients (1.6 %) transient ischemic attack (TIA). 30-day lethality was 4.5 %. 3 patients died due to low cardiac output, 6 patients due to extracardial reasons, 2 patients (0.8 %) developed a cerebral death.
  
  
  CONCLUSIONS
  Simultaneous CEA and cardiac surgery can be performed with an acceptable risk for neurological complications and mortality. Occlusion of contralateral carotid artery could be identified as an evident predictor for increased neurological complications. Compared to two-stage procedures, combined operations yield a reduction of hospital costs.
authors.affiliation: Department of Cardiovascular Surgery, Klinikum Bogenhausen, Munich, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Gansera
authors.forename: I
authors.initials: I
authors.lastname: Angelis
authors.forename: J
authors.initials: J
authors.lastname: Weingartner
authors.forename: P
authors.initials: P
authors.lastname: Neumaier-Prauser
authors.forename: K
authors.initials: K
authors.lastname: Spiliopoulos
authors.forename: B M
authors.initials: BM
authors.lastname: Kemkes
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000191:economics / Q000401:mortality; D002340:Carotid Artery Diseases / Q000150:complications / Q000601:surgery; D003324:Coronary Artery Disease / Q000150:complications / Q000601:surgery; D003362:Cost-Benefit Analysis; D016894:Endarterectomy, Carotid / Q000009:adverse effects* / Q000191:economics / Q000401:mortality; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000209:etiology* / Q000401:mortality