Document Detail


Long-term results of simultaneous carotid endarterectomy and myocardial revascularization with cardiopulmonary bypass used for both procedures.
MedLine Citation:
PMID:  10733767     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Controversy continues about the treatment of patients with a concomitant occlusive disease of the coronary and carotid arteries. Our operative strategy in these patients is to do simultaneous carotid endarterectomy and myocardial revascularization in conjunction with cardiopulmonary bypass with mild hypothermia. We report our experience with this kind of one-stage procedure and its retrospective long-term results. METHODS: From February 1985 to September 1998, 340 patients underwent simultaneous carotid endarterectomy and myocardial revascularization. The average age of the patients was 65.3 years; 45.6% were neurologically symptomatic, and 44.4% had bilateral carotid stenosis. The indication for carotid endarterectomy was lumen diameter reduction of more than 75%, angiographic signs of thrombogenic endovascular morphology, or both. Carotid endarterectomy was performed in conjunction with cardiopulmonary bypass with mild hypothermia, hemodilution, systemic heparinization, and controlled hemodynamics under pulsatile perfusion for additional cerebral protection. RESULTS: There were 16 perioperative neurologic complications (4.7%), 11 permanent deficits (3.2%), and 9 cardiac complications (2.6%). Early mortality was 2.6% (SE 0.8%): 2 patients had a stroke and 2 had a myocardial infarction. The 5-year survival was 78.9% (SE 2.6%), and freedom from ipsilateral stroke and cardiac event were 93.2% (SE 1.5%) and 87.5% (SE 2.1%), respectively. The predictor for early death was age over 70 years, and predictors for late death were age over 70 years, previous myocardial infarction, previous stroke, and bilateral carotid stenosis of greater than 90%. CONCLUSION: On the basis of our long-term results, we believe that simultaneous carotid endarterectomy and myocardial revascularization in conjunction with cardiopulmonary bypass is a method safe enough to prefer its routine use with acceptable low operative risk and satisfactory long-term morbidity.
Authors:
K Minami; K Fukahara; D Boethig; A Bairaktaris; D Fritzsche; R Koerfer
Related Documents :
11414077 - Long-term follow-up of saphenous vein, internal jugular vein, and knitted dacron patche...
7974557 - Writing tremor after discrete cortical infarction.
18589347 - A patient with idiopathic thrombocytopenic purpura presenting with an acute ischemic st...
1542897 - Supraventricular tachycardia in patients with right hemisphere strokes.
15837247 - Outcomes of paclitaxel-eluting stent implantation in patients with stenosis of the left...
9930057 - Transcatheter closure of a residual postmyocardial infarction ventricular septal defect...
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  119     ISSN:  0022-5223     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2000 Apr 
Date Detail:
Created Date:  2000-05-18     Completed Date:  2000-05-18     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  764-73     Citation Subset:  AIM; IM    
Affiliation:
Department of Thoracic and Cardiovascular Surgery, Heart Center North-Rhine Westfalia, Bad Oeynhausen, Germany.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Aged
Cardiopulmonary Bypass*
Coronary Artery Bypass* / adverse effects,  mortality
Endarterectomy, Carotid* / adverse effects,  mortality
Female
Follow-Up Studies
Humans
Male
Middle Aged
Risk Factors
Stroke / etiology

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


Previous Document:  Re-creation of sinuses is important for sparing the aortic valve: a finite element study.
Next Document:  Ring annuloplasty prevents delayed leaflet coaptation and mitral regurgitation during acute left ven...