title: Concomitant carotid endarterectomy and coronary bypass surgery: outcome of on-pump and off-pump techniques.
abstract: BACKGROUND
  There continues to be a dilemma regarding the best means of surgical management of significant carotid artery disease in patients requiring coronary artery bypass surgery. A combined approach of coronary artery bypass and carotid endarterectomy has shown good results in patients with concomitant carotid and coronary artery disease. We reviewed our results of coronary artery surgery using conventional cardiopulmonary bypass or off-pump techniques and carotid endarterectomy done as a combined procedure.
  
  
  METHODS
  Between January 1996 and June 2002, 358 patients underwent concomitant coronary artery bypass and carotid endarterectomy. There were 140 males (84.3%) and 26 females (15.7%) in group I. Group II consisted of 158 males (82.3%) and 34 females (17.7%). One hundred sixty-six patients (group I) were done off pump whereas in 192 patients (group II), the procedure was done using conventional cardiopulmonary bypass. Carotid endarterectomy was performed before coronary artery bypass surgery in both groups.
  
  
  RESULTS
  The average number of grafts were 3.4 +/- 0.8 with average operative time of 4.2 +/- 0.4 hours in group I, and 3.3 +/- 0.8 graft with operative time of 5.3 +/- 1.2 hours in group II (p = 0.239 and p < 0.001, respectively). There were 2 deaths (1.2%) in group I and 3 deaths (1.6%) in group II (p = 0.870). No patient from group I and 1 patient (0.5%) from group II had postoperative stroke (p = 0.941). Mean hospital stay was 9.0 +/- 1.2 days in group I and 11.2 +/- 1.7 days in group II (p < 0.001). At mean follow-up of 2.8 +/- 0.9 years in group I, 2 patients (1.2%) had late death due to cardiac failure and contralateral carotid endarterectomy was done in 2 patients (1.2%). Group II had mean follow-up of 2.4 +/- 0.6 years, during which 4 patients (2.1%) had late death and contralateral carotid endarterectomy was done in 3 patients (1.6%). Late stroke was seen in 1 patient (0.6%) from group I and 2 patients (1.0%) from group II.
  
  
  CONCLUSIONS
  Concomitant carotid endarterectomy and coronary artery bypass is a safe and effective procedure in patients with significant coronary and carotid artery disease. Equally good results can be reproduced using cardiopulmonary bypass or off-pump techniques for coronary artery surgery, with low morbidity, mortality, and good long-term results.
authors.affiliation: Department of Cardiovascular Surgery, Escorts Heart Institute and Research Centre, New Delhi, India. dryugal@yahoo.com
authors.forename: Yugal
authors.initials: Y
authors.lastname: Mishra
authors.forename: Harpreet
authors.initials: H
authors.lastname: Wasir
authors.forename: Vijay
authors.initials: V
authors.lastname: Kohli
authors.forename: Zile Singh
authors.initials: ZS
authors.lastname: Meharwal
authors.forename: Rajneesh
authors.initials: R
authors.lastname: Malhotra
authors.forename: Yatin
authors.initials: Y
authors.lastname: Mehta
authors.forename: Naresh
authors.initials: N
authors.lastname: Trehan
mesh_terms: D000368:Aged; D016893:Carotid Stenosis / Q000150:complications / Q000601:surgery*; D001026:Coronary Artery Bypass / Q000379:methods / Q000401:mortality; D047549:Coronary Artery Bypass, Off-Pump; D003327:Coronary Disease / Q000150:complications / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000379:methods / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006406:Hematoma / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D011183:Postoperative Complications; D012189:Retrospective Studies; D020521:Stroke / Q000209:etiology; D016896:Treatment Outcome