Selective screening for asymptomatic carotid artery disease prior to isolated heart valve surgery.
OBJECTIVE
To assess the yield of screening for asymptomatic carotid artery disease prior to isolated heart valve surgery (IHVS).


METHODS
Retrospective analysis of the preoperative carotid duplex scans performed in neurologically asymptomatic patients who underwent IHVS between 2003 and 2006 was performed. Internal carotid artery (ICA) stenosis of 70% was considered significant. Patients with concomitant coronary artery disease were excluded.


RESULTS
A total of 177 patients underwent IHVS (one valve in 165 and 2 valves in 12 patients). No or minor ICA disease detected in 172 patients. Four patients (2.25%) had significant unilateral ICA stenosis and 1 patient (0.56%) had unilateral ICA occlusion. Three patients (1.69%) suffered postoperative stroke, while 2 patients (1.1%) suffered transient ischemic attacks. All neurologically affected patients had normal preoperative carotid duplex. The in-hospital mortality was 4.5%.


CONCLUSIONS
Prevalence of significant ICA disease is low in patients undergoing IHVS. This population does not benefit from preoperative carotid screening.
Zayed
Hany
H
King's College Hospital, Denmark Hill, London.
Ali
Ahmad
A
Wendler
Olaf
O
Rashid
Hisham
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging*; D016893:Carotid Stenosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D002546:Ischemic Attack, Transient / Q000209:etiology; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D011237:Predictive Value of Tests; D011300:Preoperative Care; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000209:etiology; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex