Investigation of the Postoperative Complications Rate and Predictors in Patients Undergoing Surgery due to Associated Carotid and Coronary Occlusive Disease
Background: The aim of this study was to evaluate the frequency of postoperative complications in patients who underwent coronary artery bypass grafting (CABG) and simultaneous carotid endarterectomy (CEA) and find predictors of postoperative complications.
Methods: We retrospectively evaluated 86 patients after simultaneous CABG and CEA. Inclusion criteria were: patients with asymptomatic carotid stenosis with a reduction of the carotid lumen diameter of more than 70% detected with Doppler ultrasound and diagnosed with one, two, or three vessel coronary artery disease with coronary stenosis more than 75% and hemodynamic significant stenosis of the left main artery. Exclusion criteria were patients with urgent and previous cardiac surgery and patients with myocardial infarction and stroke in the past one month. We monitored preoperative (ejection fraction, coronarography status), operative (number of grafts, on-pump or off-pump technique) and postoperative (extubation, unit care and hospital stay, bleeding and reoperation) details and complications (myocardial infarction, neurological events, inotropic agents and transfusion requiry, infection, arrhythmic complication, renal failure, mortality).
Results: Postoperative complications were observed in 18 (29.9%) patients. Two patients (2.3%) had postoperative stroke and one patient (1.2%) had transient ischemic attack (TIA). Previous stroke was a predictor for increased postoperative neurological events (P < .05). Intrahospital mortality was 8.1%.
Conclusion: Simultaneous CEA and CABG were performed with low rates of stroke and TIA. Previous stroke was identified as a predictor for increased postoperative neurological complications.
Aydin E, Ozen Y, Sarikaya S, Yukseltan I. 2014. Simultaneous coronary artery bypass grafting and carotid endarterectomy can be performed with low mortality rates Cardiovasc J Afr 25:130-3.
Brener BJ, Brief DK, Alpert J, Goldenkranz RJ, Personnet V. 1987. The risk of stroke in patients with asymptomatic carotid stenosis undergoing cardiac surgery: a follow-up study. J Vasc Surg 5:269-79.
Busch T, Sirbu H, Aleksic I, et al. 1999. Combined approach for internal carotid artery stenosis and cardiovascular disease in septuagenarians-a comparative study. Eur J Cardiothorac Surg 16:602-6.
Cywinski JB, Koch CG, Krajewski LP, Smedira N, Li L, Starr NJ. 2006. Increased risk associated with combined carotid endarterectomy (CEA) and coronary artery bypass graft surgery: a propensity-matched comparison with isolated coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth 20:796-802.
Eren E, Balkanay M, Toker ME, et al. 2005. Simultaneous carotid endarterectomy and coronary revascularization is safe using either on-pump or off-pump technique. Int Heart J 46:783-93.
Gansera B, Schmidtler F, Weingartner J, et al. 2012. Simultaneous carotid endarterectomy and cardiac surgery: early results of 386 patients. Thorac Cardiovasc Surg 60:508-16.
Gopaldas RR, Chu D, Dao TK, et al. 2011. Staged versus synchronous carotid endarterectomy and coronary artery bypass grafting: analysis of 10-year nationwide outcomes. Ann Thorac Surg 91:1323-9.
Huh J, Wall M, Soltero E. 2003. Treatment of combined coronary and carotid artery disease. Curr Opin Cardiol 18:447-53.
Illuminati G, Ricco J-B, Caliò F, et al. 2011. Short-term results of a randomized trial examining timing of carotid endarterectomy in patients with severe asymptomatic unilateral carotid stenosis undergoing coronary artery bypass grafting. J Vasc Surg 54:993-9.
John R, Choudhri AF, Weinberg AD, et al. 2000. Multicenter review of preoperative risk factors for stroke after coronary artery bypass grafting. Ann Thorac Surg 69:30-5.
Khaitan L, Sutter FP, Goldman SM, et al. 2000. Simultaneous carotid endarterectomy and coronary revascularization. Ann Thorac Surg 69:421-4.
Kolh PH, Comte L, Tchana-Sato V, et al. 2006. Concurrent coronary and carotid artery surgery: factors influencing perioperative outcome and long-term results. Eur Heart J 27:49-56.
Kougias P, Kappa JR, Sewell DH, Feit RA, Michalik RE. 2007. Simultaneous carotidendarterectomy and coronary artery bypass grafting: results in specific patient groups. Ann Vasc Surg 21:408-14.
Levy E, Yakubovitch D, Rudis E, et al. 2012. The role of combined carotid endarterectomy and coronary artery bypass grafting in the era of carotid stenting in view of long-term results. Interact Cardiovasc Thorac Surg 15:984-8.
Likosky DS, Marrin CA, Caplan LR, et al. 2003. Determination of etiologic mechanisms of strokes secondary to coronary artery bypass graft sur¬gery. Northern New England Cardiovascular Disease Study Group Stroke 34:2830-4.
Naylor AR, Cuffe RL, Rothwell PM, Bell PR. 2003. A systematic review of out¬comes following staged and synchronous carotid endarterectomy and coronary artery bypass. Eur J Vasc Endovasc Surg 25:380-9.
Naylor AR. 2010. Managing patients with symptomatic coronary and carotid artery disease. Perspect Vasc Surg Endovasc Ther 22:70-6.
Naylor AR, Bown MJ. 2011. Stroke after cardiac surgery and its association with asymptomatic carotid disease: an updated systematic review and metaanalysis. Eur J Vasc Endovasc Surg 41:607-24.
Nwakanma L, Poonyagariyagorn HK, Bello R, Khoynezhad A, Smego D, Plestis KA. 2006. Early and late results of combined carotid endarterectomy and coronary artery bypass versus isolated coronary artery bypass. Interact Cardiovasc Thorac Surg 5:159-65.
Prasad SM, Shuang Li, Rankin JS, et al. 2010. Current outcomes of simultaneous carotid endarterectomy and coronary artery bypass graft surgery in North America. World J Surg 34:2292-98.
Ren S, Liu P, Ma G, Wang F, Qian S, Fan X. 2012. Long-term outcomes of synchronous carotid endarterectomy and coronary artery bypass grafting versus solely carotid endarterectomy. Ann Thorac Cardiovasc Surg 18:228-35.
Timaran CH, Rosero EB, Smith ST et al. 2008. Trends and outcomes of con¬current carotid revascularization and coronary bypass. J Vasc Surg 48:355-60.
Trachiotis GD, Pfister AJ. 1997. Management strategy for simultaneous carotid endarterectomy and coronary revascularization. Ann Thorac Surg 64:1013-18. (Akins LW, Moncure AC, Daggett WM. 1995. Safety and efficiency of concomitant carotid and coronary artery operations Ann Thorac Surg 60:311-17.)
Yuan SM, Wu HW, Jing H. 2009. Treatment strategy for combined carotid artery stenosis and coronary artery disease: staged or simultaneous surgical procedure? Tohoku J Exp Med 219:243-50.
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