A Retrospective Study of Combined Cardiac and Carotid Surgery

Introduction: A combined carotid endarterectomy (CEA) and cardiac procedure has higher early risk of stroke than isolated CEA because of the widespread atherosclerosis in patients selected for simultaneous procedures. In this retrospective study, we review the results of combined coronary artery byp...

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Main Authors: Fabrizio Sansone, Edoardo Zingarelli, Giuseppe Punta, Stefano Del Ponte, Gianluca Bardi, Roberto Flocco, Piergiuseppe Forsennati, Francesco Parisi, Guglielmo Mario Actis Dato, Andrea Gaggiano, Emanuele Ferrero, Andrea Viazzo, Franco Nessi, Riccardo Casabona
Format: Article
Language:English
Published: GESDAV 2012-08-01
Series:Archives of Clinical and Experimental Surgery
Subjects:
Online Access:http://www.scopemed.org/fulltextpdf.php?mno=16212
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spelling doaj-4e3efaf985eb4ae6bc2446e6af1138212020-11-24T23:51:53ZengGESDAVArchives of Clinical and Experimental Surgery2146-81332012-08-011420120510.5455/aces.2012041112042616212A Retrospective Study of Combined Cardiac and Carotid SurgeryFabrizio Sansone0Edoardo Zingarelli1Giuseppe Punta2Stefano Del Ponte3Gianluca Bardi4Roberto Flocco5Piergiuseppe Forsennati6Francesco Parisi7Guglielmo Mario Actis Dato8Andrea Gaggiano9Emanuele Ferrero10Andrea Viazzo11Franco Nessi12Riccardo Casabona13Division of Cardiac Surgery, Mauriziano Hospital Largo Turati 62, 10126, Turin, Italy Division of Cardiac Surgery, Mauriziano Hospital Largo Turati 62, 10126, Turin, Italy Division of Cardiac Surgery, Mauriziano Hospital Largo Turati 62, 10126, Turin, Italy Division of Cardiac Surgery, Mauriziano Hospital Largo Turati 62, 10126, Turin, Italy Division of Cardiac Surgery, Mauriziano Hospital Largo Turati 62, 10126, Turin, Italy Division of Cardiac Surgery, Mauriziano Hospital Largo Turati 62, 10126, Turin, Italy Division of Cardiac Surgery, Mauriziano Hospital Largo Turati 62, 10126, Turin, ItalyIntroduction: A combined carotid endarterectomy (CEA) and cardiac procedure has higher early risk of stroke than isolated CEA because of the widespread atherosclerosis in patients selected for simultaneous procedures. In this retrospective study, we review the results of combined coronary artery bypass grafting (CABG) and carotid endarterectomy (CEA) procedures. Materials and methods: Between January 2000 and December 2007, 91 patients with a mean age of 69.2+6.6 (24/67 female/male) underwent combined operations (CEA-CABG) on cardiopulmonary bypass (CPB) as elective surgery. The study population was divided, as follows: Group A: 83 patients (91.2%) had both venous and arterial revascularization; Group B: 8 patients (8.8%) had total arterial revascularization. CEA was performed in case of stenosis more than 80% and always before cardiac operation. These techniques were used: standard procedure (54.8%), eversion (39.2%), patch enlargement (6%). Immediately after the vascular procedure, CABGs were performed through median sternotomy. The mean EUROscore was 6.9+2.5%. Results: All neurological complications were in the group who underwent both venous and arterial revascularization (Group A), where a proximal anastomosis was made. All complications and deaths were in group A. Six patients had stroke (6.6%) and 2 had acute myocardial infarction (AMI) (2.2%). There were 8 in-hospital deaths (8.8%) and 1 late death (for stroke after five months). Conclusions: In our center, the incidence of stroke in simultaneous cardiovascular procedures was 5.5 times greater than in isolated cardiac or vascular procedures, which was probably related to the widespread vessels disease. An aortic cross clamp and surgical procedure on the ascending aorta are relevant risk factors for developing neurological events; much attention should be paid to aortic manipulation. In the sub-group who underwent total arterial revascularization with associated CEA procedures, we had no neurological events. A partial cross clamp and proximal anastomosis are relevant risk factors for developing neurological events. Therefore, in combined operations (CEA associated with CABG), it is probably more favourable performing a total arterial revascularization, avoiding partial ascending aortic clamping. [Arch Clin Exp Surg 2012; 1(4.000): 201-205]http://www.scopemed.org/fulltextpdf.php?mno=16212Carotid endoarterectomycoronary artery by-pass grafting
collection DOAJ
language English
format Article
sources DOAJ
author Fabrizio Sansone
Edoardo Zingarelli
Giuseppe Punta
Stefano Del Ponte
Gianluca Bardi
Roberto Flocco
Piergiuseppe Forsennati
Francesco Parisi
Guglielmo Mario Actis Dato
Andrea Gaggiano
Emanuele Ferrero
Andrea Viazzo
Franco Nessi
Riccardo Casabona
spellingShingle Fabrizio Sansone
Edoardo Zingarelli
Giuseppe Punta
Stefano Del Ponte
Gianluca Bardi
Roberto Flocco
Piergiuseppe Forsennati
Francesco Parisi
Guglielmo Mario Actis Dato
Andrea Gaggiano
Emanuele Ferrero
Andrea Viazzo
Franco Nessi
Riccardo Casabona
A Retrospective Study of Combined Cardiac and Carotid Surgery
Archives of Clinical and Experimental Surgery
Carotid endoarterectomy
coronary artery by-pass grafting
author_facet Fabrizio Sansone
Edoardo Zingarelli
Giuseppe Punta
Stefano Del Ponte
Gianluca Bardi
Roberto Flocco
Piergiuseppe Forsennati
Francesco Parisi
Guglielmo Mario Actis Dato
Andrea Gaggiano
Emanuele Ferrero
Andrea Viazzo
Franco Nessi
Riccardo Casabona
author_sort Fabrizio Sansone
title A Retrospective Study of Combined Cardiac and Carotid Surgery
title_short A Retrospective Study of Combined Cardiac and Carotid Surgery
title_full A Retrospective Study of Combined Cardiac and Carotid Surgery
title_fullStr A Retrospective Study of Combined Cardiac and Carotid Surgery
title_full_unstemmed A Retrospective Study of Combined Cardiac and Carotid Surgery
title_sort retrospective study of combined cardiac and carotid surgery
publisher GESDAV
series Archives of Clinical and Experimental Surgery
issn 2146-8133
publishDate 2012-08-01
description Introduction: A combined carotid endarterectomy (CEA) and cardiac procedure has higher early risk of stroke than isolated CEA because of the widespread atherosclerosis in patients selected for simultaneous procedures. In this retrospective study, we review the results of combined coronary artery bypass grafting (CABG) and carotid endarterectomy (CEA) procedures. Materials and methods: Between January 2000 and December 2007, 91 patients with a mean age of 69.2+6.6 (24/67 female/male) underwent combined operations (CEA-CABG) on cardiopulmonary bypass (CPB) as elective surgery. The study population was divided, as follows: Group A: 83 patients (91.2%) had both venous and arterial revascularization; Group B: 8 patients (8.8%) had total arterial revascularization. CEA was performed in case of stenosis more than 80% and always before cardiac operation. These techniques were used: standard procedure (54.8%), eversion (39.2%), patch enlargement (6%). Immediately after the vascular procedure, CABGs were performed through median sternotomy. The mean EUROscore was 6.9+2.5%. Results: All neurological complications were in the group who underwent both venous and arterial revascularization (Group A), where a proximal anastomosis was made. All complications and deaths were in group A. Six patients had stroke (6.6%) and 2 had acute myocardial infarction (AMI) (2.2%). There were 8 in-hospital deaths (8.8%) and 1 late death (for stroke after five months). Conclusions: In our center, the incidence of stroke in simultaneous cardiovascular procedures was 5.5 times greater than in isolated cardiac or vascular procedures, which was probably related to the widespread vessels disease. An aortic cross clamp and surgical procedure on the ascending aorta are relevant risk factors for developing neurological events; much attention should be paid to aortic manipulation. In the sub-group who underwent total arterial revascularization with associated CEA procedures, we had no neurological events. A partial cross clamp and proximal anastomosis are relevant risk factors for developing neurological events. Therefore, in combined operations (CEA associated with CABG), it is probably more favourable performing a total arterial revascularization, avoiding partial ascending aortic clamping. [Arch Clin Exp Surg 2012; 1(4.000): 201-205]
topic Carotid endoarterectomy
coronary artery by-pass grafting
url http://www.scopemed.org/fulltextpdf.php?mno=16212
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