Simultaneous coronary and carotid revascularisation

IntroductionCoronary artery disease is the most frequent cardiovascular disease at all. Combination of coronary and carotid artery disease due to multisystem atherosclerosis is an indicator of impaired prognosis. Patients with existing coronary artery disease who undergo carotid endarterectomy (CEA) are at high risk of developing perioperative myocardial infarction. There is also increased risk of perioperative stroke in patients with severe carotid artery stenosis who undergo coronary artery bypass grafting (CABG). There is possibility to perform simultaneous CEA/CABG in selected cases to prevent these severe complications.Materials and methodsDuring 5 years period, between January 2010 and December 2014, 54 patients (46 males, 8 females, mean age 70.3 years, range 52–85) underwent simultaneous CEA/CABG surgery for significant coexisting carotid and coronary artery disease in our institution. Demographic and clinical characteristics of the patients as well as a history of previous myocardial infarction, hypertension, diabetes mellitus, hyperlipidaemia, peripheral arterial disease and smoking were recorded. Carotid pathology was diagnosed by ultrasound scan and CT angiography. The combined procedures were performed with the patients under general anesthesia. The CEA was completed first, and than CABG was performed.ResultsThe mean postoperative hospital stay was 14.5 days (range 7–95 days). We recorded one death due to colon necrosis in our group of patients. The hospitalization mortality was 1.9%. There was no perioperative myocardial infarction. One patient with symptomatic unilateral carotid stenosis developed reversible ischemic neurologic deficit. One patient required intraaortic balloon counterpulsation as a result of postoperative heart failure. We observed impaired wound heeling in 5 patients. Other perioperative morbidity included atrial fibrilation in 17 patients, transient delirium in 15 patients and postoperative hemopericardium in 1 patient.ConclusionAccording to our experiences and results, the simultaneous performance of CEA and CABG in patients with severe coexisting carotid artery disease who require coronary revascularization has proved to be a safe and efficacious operative strategy in these high-risk patients.