Synchronous or Staged Carotid Endarterectomy and Coronary Artery Bypass Grafting? Propensity score matched study

  • Sebastian Hempe Department of Thoracic and Cardiovascular Surgery, University Hospital RWTH Aachen, Pauwelsstrasse 30, Aachen 52074, Germany
  • Ajay Moza Department of Thoracic and Cardiovascular Surgery, University Hospital RWTH Aachen, Pauwelsstrasse 30, Aachen 52074, Germany
  • Andreas Goetzenich Department of Thoracic and Cardiovascular Surgery, University Hospital RWTH Aachen, Pauwelsstrasse 30, Aachen 52074, Germany
  • Lachmandath Tewarie Department of Thoracic and Cardiovascular Surgery, University Hospital RWTH Aachen, Pauwelsstrasse 30, Aachen 52074, Germany
  • Christian Bleilevens Department of Anesthesiology, University Hospital RWTH Aachen, Pauwelsstrasse 30, Aachen 52074, Germany
  • Rüdiger Autschbach Department of Thoracic and Cardiovascular Surgery, University Hospital RWTH Aachen, Pauwelsstrasse 30, Aachen 52074, Germany
  • Heike Schnoering Department of Thoracic and Cardiovascular Surgery, University Hospital RWTH Aachen, Pauwelsstrasse 30, Aachen 52074, Germany
  • Rashad Zayat Department of Thoracic and Cardiovascular Surgery, University Hospital RWTH Aachen, Pauwelsstrasse 30, Aachen 52074, Germany

Abstract

Background: The optimal treatment strategy in patients presenting with hemodynamically significant carotid artery disease who are to undergo cardiac surgery, remains controversial. In this study, we retrospectively analyzed the outcome data of patients receiving synchronous or staged coronary artery bypass graft (CABG) surgery and carotid endarterectomy (CEA).

Methods: Between 2011 and 2016, 3173 patients underwent CABG surgery in our institution, of whom 323 received CABG and CEA either as synchronous (N = 307) or as staged (N = 16) procedures. Patients´ characteristics, peri- and postoperative data were collected from our digital medical database. Propensity score matching was used to match each patient from the staged group to two appropriate patients (1:2 matching) from the synchronous group (synchronousmatched).

Results: The overall incidence of ischemic stroke (IS) and transitory ischemic attack (TIA) was 4.9% and 5.6%, respectively. No hemorrhagic stroke was noted in both groups. Incidence of IS did not differ significantly between matched groups (P = 1.000). Significantly higher rates of postoperative neurological complications, such as TIA and delirium, were found in the synchronousmatched group (P = .041 and P = .043, respectively) compared with the staged group. Additionally, there were more postoperative respiratory insufficiencies in the synchronousmatched group (P = .043). Thirty days mortality did not differ significantly between the matched groups.

Conclusion: In this experience combined with the data given in literature, our findings suggest a possible superiority of the staged CABG/CEA approach. Large, randomized studies are required to verify our findings and to establish applicable guidelines.

Author Biographies

Sebastian Hempe, Department of Thoracic and Cardiovascular Surgery, University Hospital RWTH Aachen, Pauwelsstrasse 30, Aachen 52074, Germany

Department of Thoracic and Cardiovascular Surgery

Ajay Moza, Department of Thoracic and Cardiovascular Surgery, University Hospital RWTH Aachen, Pauwelsstrasse 30, Aachen 52074, Germany

Department of Thoracic and Cardiovascular Surgery

Andreas Goetzenich, Department of Thoracic and Cardiovascular Surgery, University Hospital RWTH Aachen, Pauwelsstrasse 30, Aachen 52074, Germany

Department of Thoracic and Cardiovascular Surgery

Lachmandath Tewarie, Department of Thoracic and Cardiovascular Surgery, University Hospital RWTH Aachen, Pauwelsstrasse 30, Aachen 52074, Germany

Department of Thoracic and Cardiovascular Surgery

Christian Bleilevens, Department of Anesthesiology, University Hospital RWTH Aachen, Pauwelsstrasse 30, Aachen 52074, Germany

Department of Anaesthesiology

Rüdiger Autschbach, Department of Thoracic and Cardiovascular Surgery, University Hospital RWTH Aachen, Pauwelsstrasse 30, Aachen 52074, Germany

University Hospital RWTH Aachen
Department of Thoracic and Cardiovascular Surgery

Heike Schnoering, Department of Thoracic and Cardiovascular Surgery, University Hospital RWTH Aachen, Pauwelsstrasse 30, Aachen 52074, Germany

Department of Thoracic and Cardiovascular Surgery

Rashad Zayat, Department of Thoracic and Cardiovascular Surgery, University Hospital RWTH Aachen, Pauwelsstrasse 30, Aachen 52074, Germany

Department of Thoracic and Cardiovascular Surgery

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Published
2018-08-17
Section
Articles