title: Asymptomatic carotid artery disease in valvular heart surgery: impact of systematic screening on surgical strategy and neurological outcome.
abstract: We evaluated the prevalence of asymptomatic carotid artery disease in patients scheduled for valvular cardiac surgery. Preoperative screening of the carotid arteries was performed. Among 1012 patients scheduled for valvular cardiac surgery, 267 (26.4%) had carotid stenosis graded >50%; 37 had carotid stenosis >70% and underwent combined valvular surgery and carotid endarterectomy (CEA); and 230 (86%) had carotid stenosis >50% to ≤ 69% and received valvular cardiac surgery under hypothermic cardiopulmonary bypass. Operative mortality and the rate of perioperative adverse neurological events were comparable among the groups. During 6.8 years of follow-up, patients with carotid stenosis not exceeding 69% at the time of surgery had CEA more frequently (P < .05) and stroke/transient ischemic attack ([TIA] P < .05) versus patients treated with combined surgery. The prevalence of asymptomatic carotid stenosis is not negligible in patients undergoing isolated valvular surgery. Combined valvular and carotid surgery is safe and reduces the incidence of CEA and stroke/TIA during follow-up.
authors.affiliation: Division of Cardiac Surgery, Catholic University, Rome, Italy. amedeo.anselmi@alice.it
authors.forename: Amedeo
authors.initials: A
authors.lastname: Anselmi
authors.forename: Mario
authors.initials: M
authors.lastname: Gaudino
authors.forename: Nicola
authors.initials: N
authors.lastname: Risalvato
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lauria
authors.forename: Franco
authors.initials: F
authors.lastname: Glieca
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016893:Carotid Stenosis / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D015331:Cohort Studies; D016894:Endarterectomy, Carotid; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications / Q000473:pathology / Q000601:surgery*; D006801:Humans; D002546:Ischemic Attack, Transient / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D015995:Prevalence; D020521:Stroke / Q000453:epidemiology; D016896:Treatment Outcome