Document Detail


Combined carotid and cardiac surgery: improving the results.
MedLine Citation:
PMID:  20471217     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Aim of this study was to analyze our experience in the last 5 years of combined carotid and cardiac surgery. METHODS: During a 5-year period (January 2002-December 2006), 111 patients underwent combined carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG) (group 1), while 1,446 patients underwent isolated CEA (group 2). Perioperative outcomes in the two groups were compared using chi(2) and Fisher's exact tests to analyze neurological deficits, cardiac events, and death at 30 days. Results during follow-up were analyzed using Kaplan-Meier survival curves, and both groups were compared using the log-rank test. RESULTS: Immediate postoperative neurological deficits occurred more frequently in group 1 patients (2.5 vs. 0.4%, p = 0.002), with a higher incidence of transient ischemic attacks in group 1; however, there was no difference in the incidence of stroke (1% group 1 vs. 0.6% group 2, p = n.s.). Mortality rate was increased in the combined surgery group (3.5 vs. 0.5%, p < 0.001). Combined stroke/myocardial infarction/death rate at 30 days was 6.3% in group 1 compared with 1.4% in group 2, p = 0.001. Perioperative stroke/myocardial infarction/death rate was much improved in the 55% (61/111) of patients undergoing CABG off-pump (3.3 vs. 10%, p = 0.001). Mean follow-up was 18.7 months (range, 1-60). Survival at 24 months was significantly higher in patients of group 2 compared with group 1 (99.4 vs. 91.3% respectively, p < 0.001). At 24 months, there was no significant difference between the two groups in the risk of developing ipsilateral or contralateral neurologic events (3.1% group 1 vs. 1.7% group 2). CONCLUSION: In our experience, combined CEA and cardiac surgery carries a higher risk of perioperative mortality than patients undergoing isolated CEA. Whenever possible, CEA combined with off-pump CABG seems to be the therapeutic strategy of choice.
Authors:
Emiliano Chiti; Nicola Troisi; John Marek; Walter Dorigo; Alessandro Alessi Innocenti; Raffaele Pulli; Pierluigi Stefano; Carlo Pratesi
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Publication Detail:
Type:  Journal Article     Date:  2010-05-13
Journal Detail:
Title:  Annals of vascular surgery     Volume:  24     ISSN:  1615-5947     ISO Abbreviation:  Ann Vasc Surg     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-07-19     Completed Date:  2010-10-26     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8703941     Medline TA:  Ann Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  794-800     Citation Subset:  IM    
Copyright Information:
Copyright 2010 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.
Affiliation:
Department of Vascular Surgery, University of Florence, Florence, Italy.
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MeSH Terms
Descriptor/Qualifier:
Aged
Carotid Artery Diseases / complications,  mortality,  surgery*
Chi-Square Distribution
Coronary Artery Bypass* / adverse effects,  mortality
Coronary Artery Bypass, Off-Pump
Coronary Artery Disease / complications,  mortality,  surgery*
Endarterectomy, Carotid* / adverse effects,  mortality
Female
Humans
Ischemic Attack, Transient / etiology
Italy
Kaplan-Meiers Estimate
Male
Myocardial Infarction / etiology
Patient Selection
Risk Assessment
Risk Factors
Stroke / etiology
Time Factors
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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