European Heart Journal Advance Access published online on September 23, 2005
European Heart Journal, doi:10.1093/eurheartj/ehi494
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
1 Cardiothoracic Surgery Department, University Hospital of Liège, B 35 Sart Tilman, 4000 Liège, Belgium
* To whom correspondence should be addressed. Aims To assess risk factors for early and late outcome after concurrent carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG). Methods and results Records of all 311 consecutive patients having concurrent CEA and CABG from 1989 to 2002 were reviewed, and follow-up obtained (100% complete). In the group (mean age 67 years; 74% males), 62% had triple-vessel disease, 57% unstable angina, 31% left main coronary stenosis, 19% congestive heart failure, and 35% either a history of vascular procedures or existing vasculopathies. Preoperative assessment revealed transient ischaemic attack in 16%, stroke in 7%, and bilateral carotid disease in 20%. There were 7% emergent and 19% urgent operations, and ascending aorta was described as atheromatous or calcified in 21%. Hospital death occurred in 19 patients, myocardial infarction in seven, and permanent stroke in 12. Significant multivariable predictors of hospital death were aortic calcifications, coexisting vasculopathy, and emergent procedure. Significant predictors of postoperative stroke were calcified or dilated aorta, and of prolonged hospital stay were advanced age, unstable angina, and coexisting vascular disease. For hospital survivors, 10-year actuarial late event-free rates were: death, 50%; myocardial infarction, 84%; stroke, 93%; percutaneous angioplasty, 95%; redo CABG, 98%; and all morbidity and mortality, 48%. Significant multivariable predictors of late deaths were coexisting vasculopathy, age, renal insufficiency, previous cardiac surgery, tobacco abuse, calcified or atheromatous aorta, and duration of intensive care unit stay. Conclusion Concurrent CEA and CABG can be performed with acceptable operative mortality and morbidity, and good long-term freedom from coronary and neurologic events. Atheromatous aortic disease is a harbinger of poor operative and long-term outcome.
Received January 4, 2005
Revised July 11, 2005
Accepted August 18, 2005
Clinical research
Concurrent coronary and carotid artery surgery: factors influencing perioperative outcome and long-term results
2 Department of Biostatistics, University Hospital of Liège, Liège, Belgium
Philippe H. Kolh, E-mail: philippe.kolh{at}chu.ulg.ac.be
Abstract 
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  M. Guerra, J. C. Mota, M. Veloso, V. Gama, and L. Vouga Combined carotid stenting and urgent coronary artery surgery in unstable angina patients with severe carotid stenosis Interactive CardioVascular and Thoracic Surgery, August 1, 2009; 9(2): 278 - 281. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. L. Brown, T. M. Sundt III, and B. J. Gersh Indications for Revascularization Card. Surg. Adult, January 1, 2008; 3(2008): 551 - 572. [Full Text]
|
|
|
|
 |
|
 M. Roffi Management of Patients With Concomitant Severe Coronary and Carotid Artery Disease: Is There a Perfect Solution? Circulation, October 30, 2007; 116(18): 2002 - 2004. [Full Text] [PDF]
|
|
|
|
 |
|
 F. Barili, G. Polvani, V. K. Topkara, L. Dainese, and P. Biglioli Concurrent coronary and carotid artery surgery: an open debate Eur. Heart J., May 2, 2006; 27(10): 1258 - 1259. [Full Text] [PDF]
|
|
|
|
|
|
P. Kolh and R. Limet Concurrent coronary and carotid artery surgery: an open debate: reply Eur. Heart J., May 2, 2006; 27(10): 1259 - 1260. [Full Text] [PDF]
|
|