COMBINED CAROTID AND CARDIAC PROCEDURES - IMPROVED RESULTS AND SURGICAL APPROACH

Severe cerebrovascular complications following cardiac surgical proced ures remain a major concern, particularly in patients with significant carotid atherosclerotic involvement (14% of perioperative stroke). Op erative mortality for carotid operations in patients with documented C oronary Artery Disease (CAD) may be as high as 20%. Seventy patients u nderwent combined operations (unilateral carotid stenosis > 70%, unila teral stenosis > 50% with ulcerated plaque or bilateral stenoses > 50% ; and this also included patients with unilateral occlusion). Cardiac procedures were 69 coronary artery bypass grafts, four left ventricula r aneurysmectomies, three aortic valve replacements and surgery on two mitral valves. Seven perioperative deaths occurred, which were all ca used by cardiac events. There were no perioperative strokes. Carotid e ndarterectomy immediately before cardiopulmonary bypass is a safe and expeditious approach to coexisting significant cardiac and carotid dis ease. In our experience. technical details in monitoring and minimizin g cerebral ischemia are possibly more crucial in these severe vasculop athic patients. Moreover. it is probably advantageous from an economic standpoint compared with other therapeutic treatments. (C) 1998 The I nternational Society for Cardiovascular Surgery. Published by Elsevier Science Ltd. All rights reserved.