Operative outcome of simultaneous carotid and valvular surgery.
BACKGROUND
Operative outcome of simultaneous carotid endarterectomy and valvular surgery has not been clarified. We retrospectively reviewed short-term and long-term outcomes after carotid endarterectomy combined with valvular replacement.


METHODS
Seventy-nine patients (50 men and 29 women. mean age, 68.9 +/- 6.9 years; range, 53.3 to 78.7 years) underwent carotid endarterectomy combined with valve replacement from February 1985 to April 2002. Indication of carotid endarterectomy was more than 75% carotid stenosis with or without ulceration. Thirteen patients had history of stroke. Endarterectomy was performed under mild hypothermia with cardiopulmonary bypass in all cases. Positions of replaced valves were aortic in 64 patients, mitral in 10, and mitral and aortic in 5 patients.


RESULTS
There were 8 early deaths (10.1%). Early neurologic complications occurred in 8 patients (10.1%); two late events were observed. Double valve replacement was an independent risk factor for early death (p = 0.039; odds ratio = 25.6). For early stroke we found no statistically significant risk factor. Myocardial infarction (p = 0.022; odds ratio = 3.0) and age more than 70 years (p = 0.03; odds ratio = 2.5) were independent risk factors for premature death; we found no independent risk factor for late stroke. Permanent impairment or death as a stroke consequence was seen in 5 patients, 3 of them had ipsilateral strokes, 2 had contralateral strokes.


CONCLUSIONS
Endarterectomy can be safely performed combined with aortic valve surgery. Concomitant mitral or double valve replacement cannot be judged reliably because of the small number of patients, but they might be a high risk.
Yoda
Masataka
M
Department of Thoracic and Cardiovascular Surgery, Heart Center North Rhine-Westphalia, University of Bochum, Georgstrasse 11, 32545 Bad Oeynhausen, Germany.
Boethig
Dietmar
D
Fritzsche
Dirk
D
Horstkotte
Dieter
D
Koerfer
Reiner
R
Minami
Kazutomo
K
D000368:Aged; D001021:Aortic Valve / Q000601:surgery; D001925:Brain Damage, Chronic / Q000453:epidemiology; D002315:Cardiopulmonary Bypass; D016893:Carotid Stenosis / Q000150:complications / Q000601:surgery; D016894:Endarterectomy, Carotid / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000150:complications / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation / Q000706:statistics & numerical data; D006801:Humans; D007036:Hypothermia, Induced; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery; D009203:Myocardial Infarction / Q000150:complications; D011183:Postoperative Complications / Q000453:epidemiology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D020521:Stroke / Q000453:epidemiology; D016019:Survival Analysis; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000601:surgery