title: Simultaneous hybrid carotid stenting and coronary bypass surgery versus concomitant open carotid and coronary bypass surgery: a pilot, feasibility study.
abstract: OBJECTIVE
  Concomitant carotid and cardiac surgery carries an increased perioperative morbidity and mortality risk. Whether the hybrid procedure of carotid artery stenting (CAS) and coronary bypass surgery decreases the risk of stroke and other complications is still unknown. The aim of this study was to assess early outcomes after simultaneous hybrid CAS and coronary bypass grafting versus open concomitant carotid and coronary bypass surgery.
  
  
  METHODS
  We included 20 patients in this study. According to the protocol, all the patients were divided into two groups: Group 1 (10 patients) with hybrid CAS and coronary bypass surgery and Group 2 (10 patients) with concomitant carotid and coronary surgery. Different preoperative, intraoperative and postoperative variables were compared. The primary end point was combined incidence of stroke and death 30 days after surgery or during initial hospitalization. The secondary end points were myocardial infarction, atrial fibrillation, blood loss and need for blood transfusion and duration of intensive care unit and hospital stay.
  
  
  RESULTS
  Groups 1 and 2 were similar in preoperative characteristics including age (65.3 ± 6.8 vs 70.7 ± 7.0, P = 0.191) New York Heart Association class (2.3 ± 0.5 vs 1.8 ± 0.7, P = 0.218), EuroSCORE (2.8 ± 2.0 vs 3.6 ± 2.3, P = 0.547), the degree of carotid stenosis (79 ± 12 vs 87 ± 13%, P = 0.224) and average left ventricular ejection fraction (44.3 ± 12.4 vs 43.4 ± 13.3%, P = 0.896). Also, the groups did not differ in intraoperative variables with an exception of extracorporeal circulation time (65.7 ± 14.1 vs 90.0 + 17.4 min, P = 0.023), which was significantly shorter in Group 1. Although rare, and without significant difference, primary end point occurred only in Group 2 (1 stroke and 1 death, 20%). There was no difference in the duration of mechanical ventilation, need for transfusion and duration of intensive care unit and hospital stay between the two groups.
  
  
  CONCLUSIONS
  Although limited by a small sample size, our results show that the hybrid procedure of carotid stenting and coronary surgery might be a good therapeutic option but further extended studies are needed to assess its real value.
authors.affiliation: Department of Cardiac Surgery, Dedinje Cardiovascular Institute, University School of Medicine, Belgrade, Serbia boban.mic@gmail.com micko2006@yahoo.com.
authors.forename: Slobodan
authors.initials: S
authors.lastname: Mićović
authors.affiliation: Department of Cardiology, Dedinje Cardiovascular Institute, University School of Medicine, Belgrade, Serbia.
authors.forename: Srdjan
authors.initials: S
authors.lastname: Bošković
authors.affiliation: Department of Radiology, Dedinje Cardiovascular Institute, University School of Medicine, Belgrade, Serbia.
authors.forename: Dragan
authors.initials: D
authors.lastname: Sagić
authors.affiliation: Department of Vascular Surgery, Dedinje Cardiovascular Institute, University School of Medicine, Belgrade, Serbia.
authors.forename: Đorđe
authors.initials: Đ
authors.lastname: Radak
authors.affiliation: Department of Cardiac Surgery, Dedinje Cardiovascular Institute, University School of Medicine, Belgrade, Serbia.
authors.forename: Miodrag
authors.initials: M
authors.lastname: Perić
authors.affiliation: Department of Cardiac Surgery, Dedinje Cardiovascular Institute, University School of Medicine, Belgrade, Serbia.
authors.forename: Predrag
authors.initials: P
authors.lastname: Milojević
authors.affiliation: Department of Cardiac Surgery, Dedinje Cardiovascular Institute, University School of Medicine, Belgrade, Serbia.
authors.forename: Duško
authors.initials: D
authors.lastname: Nežić
authors.affiliation: Department of Cardiology, Dedinje Cardiovascular Institute, University School of Medicine, Belgrade, Serbia.
authors.forename: Olivera
authors.initials: O
authors.lastname: Đokić
authors.affiliation: Department of Cardiac Surgery, Dedinje Cardiovascular Institute, University School of Medicine, Belgrade, Serbia.
authors.forename: Boško
authors.initials: B
authors.lastname: Đukanović
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction; D010865:Pilot Projects; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D015607:Stents; D016896:Treatment Outcome
keywords: Carotid stenting; Coronary bypass; Hybrid procedure; Stroke