title: Early Results of Surgical Simultaneous Therapy for Significant Carotid Artery Stenosis and Heart Disease.
abstract: The purpose of this single-center, retrospective study was to review the early outcome with defined endpoints of myocardial infarction, brain injury, and death after coronary bypass grafting and simultaneous carotid endarterectomy with or without combined valve replacement.
  
  
  
  During the preoperative investigation 52 (44 males, 8 females) patients were examined by cardiac catheterization within the scope of their coronary status. In addition, all patients underwent echocardiography, CT angiography of the supra-aortic vessels, and full description of their neurologic status. Included were all patients with the need of coronary revascularization, valve disease, and either symptomatic or asymptomatic carotid artery stenosis with a maximal narrowing of >70%.
  
  
  
  There was one (2%) patient with a perioperative stroke and paresis of the upper limb. One (2%) patient experienced PRIND (2%). Eighteen (35%) patients sufferedsymptomatic transitory psychotic syndromethat fully recovered in all patients. One (2%) patient incurred a perioperative myocardial infarction that could be cured by percutaneous coronary stent implantation. Overall mortality was 4%.
  
  
  
  Simultaneous coronary bypass grafting as a single procedure or in combination with valve replacement and endarterectomy of severe carotid lesions with or without patients' history of previous stroke can be performed with a calculated low surgical risk. The complication rate for neurologic and myocardial events is low compared with the hazard of a single surgical repair. The in-hospital mortality is not significantly different to isolated procedures. The concomitant appearance of coronary stenosis and carotid artery disease is reasonable due to the nature of arteriosclerosis. In our opinion these patients benefit from a combined surgical approach.
authors.affiliation: Heart Surgery, University Hospital Giessen and Marburg GmbH, Philipps University, Marburg, Germany.
authors.forename: Marc
authors.initials: M
authors.lastname: Irqsusi
authors.affiliation: Heart Surgery, University Hospital Giessen and Marburg GmbH, Philipps University, Marburg, Germany.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Vannucchi
authors.affiliation: Heart Surgery, University Hospital Giessen and Marburg GmbH, Philipps University, Marburg, Germany.
authors.forename: Julius
authors.initials: J
authors.lastname: Beckers
authors.affiliation: WKK Perfusionstechnik GmbH, Neuss, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Kasseckert
authors.affiliation: Heart Surgery, University Hospital Giessen and Marburg GmbH, Philipps University, Marburg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Waldhans
authors.affiliation: Heart Surgery, University Hospital Giessen and Marburg GmbH, Philipps University, Marburg, Germany.|Biochemical Pharmacological Center-Cardiovascular Res Lab, Philipps University, Marburg, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Vogt
authors.affiliation: Heart Surgery, University Hospital Giessen and Marburg GmbH, Philipps University, Marburg, Germany.
authors.forename: Rainer G H
authors.initials: RGH
authors.lastname: Moosdorf
mesh_terms: D000368:Aged; D016893:Carotid Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D000072226:Computed Tomography Angiography; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D004452:Echocardiography; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000401:mortality; D005260:Female; D005858:Germany; D006349:Heart Valve Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D010291:Paresis / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome