Document Detail

A single-stage procedure for carotid endarterectomy and myocardial revascularization: early and late results.
MedLine Citation:
PMID:  16392204     Owner:  NLM     Status:  MEDLINE    
Cardiac events are some of the most frequent postoperative complications of carotid endarterectomy, while cerebrovascular accidents frequently occur in patients who have undergone coronary artery bypass grafting. The strategy for treatment of combined carotid and coronary artery disease is still controversial. We report our experience with a single-stage procedure for carotid endarterectomy and myocardial revascularization during cardiopulmonary bypass; then we evaluate our early and late results. From January 1994 through December 2001, 73 patients underwent combined myocardial revascularization and carotid endarterectomy in a single-stage procedure. Three patients (4.1%) died during the early postoperative period. Five patients (6.8%) showed temporary neurologic complications, while 1 patient (1.4%) had cerebrovascular accidents with late permanent neurologic deficit. At 5.5 +/- 2.1 years' follow-up (range: 2.6-10.4 years), 9 of the 70 surviving patients had died: 5 (71%) of cardiac-related events, 2 (2.9%) of cerebrovascular-related causes, and 2 (2.9%) of noncerebral or noncardiac causes. During the late postoperative period, 6 patients experienced cerebrovascular accidents, with a linearized rate of 2.3%/pt-yr (70% confidence interval: 1.5% to 3.2%/pt-yr), and 8 patients experienced cardiac-related events, with a linearized rate of 3.8%/pt-yr (70% confidence interval: 2.8% to 4.9%/pt-yr). A single-stage procedure for carotid endarterectomy and myocardial revascularization during cardiopulmonary bypass can be considered safe and effective when it incorporates systemic heparinization, hemodilution, and moderate hypothermia with pulsatile flow and normal blood pressure, which helps to preserve normal cerebrovascular autoregulatory mechanisms.
Luigi Di Tommaso; Gabriele Iannelli; Mario Monaco; Michele Mottola; Vincenzo De Amicis; Nicola Spampinato
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital     Volume:  32     ISSN:  0730-2347     ISO Abbreviation:  Tex Heart Inst J     Publication Date:  2005  
Date Detail:
Created Date:  2006-01-05     Completed Date:  2006-01-24     Revised Date:  2009-11-18    
Medline Journal Info:
Nlm Unique ID:  8214622     Medline TA:  Tex Heart Inst J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  271-6     Citation Subset:  IM    
Department of Cardiac Surgery, University Federico II, Naples, Italy.
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MeSH Terms
Cardiopulmonary Bypass
Carotid Artery, Internal*
Carotid Stenosis / complications,  surgery*
Coronary Stenosis / complications,  surgery*
Endarterectomy, Carotid / methods*
Follow-Up Studies
Myocardial Revascularization / methods*
Retrospective Studies
Treatment Outcome

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

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