title: Combined carotid and cardiac surgery: improving the results.
abstract: BACKGROUND
  Aim of this study was to analyze our experience in the last 5 years of combined carotid and cardiac surgery.
  
  
  METHODS
  During a 5-year period (January 2002-December 2006), 111 patients underwent combined carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG) (group 1), while 1,446 patients underwent isolated CEA (group 2). Perioperative outcomes in the two groups were compared using chi(2) and Fisher's exact tests to analyze neurological deficits, cardiac events, and death at 30 days. Results during follow-up were analyzed using Kaplan-Meier survival curves, and both groups were compared using the log-rank test.
  
  
  RESULTS
  Immediate postoperative neurological deficits occurred more frequently in group 1 patients (2.5 vs. 0.4%, p = 0.002), with a higher incidence of transient ischemic attacks in group 1; however, there was no difference in the incidence of stroke (1% group 1 vs. 0.6% group 2, p = n.s.). Mortality rate was increased in the combined surgery group (3.5 vs. 0.5%, p < 0.001). Combined stroke/myocardial infarction/death rate at 30 days was 6.3% in group 1 compared with 1.4% in group 2, p = 0.001. Perioperative stroke/myocardial infarction/death rate was much improved in the 55% (61/111) of patients undergoing CABG off-pump (3.3 vs. 10%, p = 0.001). Mean follow-up was 18.7 months (range, 1-60). Survival at 24 months was significantly higher in patients of group 2 compared with group 1 (99.4 vs. 91.3% respectively, p < 0.001). At 24 months, there was no significant difference between the two groups in the risk of developing ipsilateral or contralateral neurologic events (3.1% group 1 vs. 1.7% group 2).
  
  
  CONCLUSIONS
  In our experience, combined CEA and cardiac surgery carries a higher risk of perioperative mortality than patients undergoing isolated CEA. Whenever possible, CEA combined with off-pump CABG seems to be the therapeutic strategy of choice.
authors.affiliation: Department of Vascular Surgery, University of Florence, Florence, Italy.
authors.forename: Emiliano
authors.initials: E
authors.lastname: Chiti
authors.forename: Nicola
authors.initials: N
authors.lastname: Troisi
authors.forename: John
authors.initials: J
authors.lastname: Marek
authors.forename: Walter
authors.initials: W
authors.lastname: Dorigo
authors.forename: Alessandro Alessi
authors.initials: AA
authors.lastname: Innocenti
authors.forename: Raffaele
authors.initials: R
authors.lastname: Pulli
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Stefano
authors.forename: Carlo
authors.initials: C
authors.lastname: Pratesi
mesh_terms: D000368:Aged; D002340:Carotid Artery Diseases / Q000150:complications / Q000401:mortality / Q000601:surgery*; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D047549:Coronary Artery Bypass, Off-Pump; D003324:Coronary Artery Disease / Q000150:complications / Q000401:mortality / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000209:etiology; D007558:Italy; D053208:Kaplan-Meier Estimate; D008297:Male; D009203:Myocardial Infarction / Q000209:etiology; D018579:Patient Selection; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome