Combined approach for internal carotid artery stenosis and cardiovascular disease in septuagenarians - a comparative study

Objective: The best surgical approach for concomitant casotid artery and ca rdiac disease remains controversial. Many studies proved the safety and eff iciency of simultaneous surgery. We aimed to demonstrate the same benefits for patients greater than or equal to 70 years. Methods: We retrospectively evaluated 205 patients simultaneously operated upon between 1988 and 1998. Group A comprised patients <70 years (n = 110), group B greater than or eq ual to 70 years. (n = 95). Risk factors, neurologic and cardiac history, an giographic findings, operative data, morbidity and mortality (30-day-postop eratively) were analysed. The mean age was 62 years in group A and 75 years in group B. All patients with symptomatic carotid artery disease, stenosis >70% or ulcerative carotid disease had simultaneous surgery. Always, the c arotid artery was addressed first. Results: Patients in group B had a highe r prevalence of peripheral vascular disease (P = 0.0005), renal insufficien cy (P = 0.0011) and COPD (P = 0.03). Urgent operation was indicated in 19% of group A patients vs. 37% in group B. In group A 70% were asymptomatic re garding the carotid vs. 48% in group B. Left ventricular dysfunction was pr esent in 45% (group A)and 58% (group B). In the present study 4% in group A and 7% in group B suffered a perioperative myocardial infarction. Patholog ic changes of the contralateral carotid were found in 42 vs. 57% (A vs. B). Mortality due to cardiac causes was 1 and 5% respectively. The combination of persistent neurologic deficit and neurologic death occurred in 3% in gr oup A (n = 3) and 5% in group B (n = 5). Postoperative neuro-cognitive dysf unction was more common in group B (35 vs. 16%; P = 0.01). Conclusions: The incidence of persistent neurologic deficits and neurologic mortality in pa tients greater than or equal to 70 years is acceptable, and low in patients <70 years. Preoperative risk factors are increasing with age and arc:relat ed to the higher mortality in elderly patients. Due to our results we will conclude that the combined approach for carotid stenosis and cardiovascular disease is the method of choice in this high-risk population. (C) 1999 Els evier Science B.V. All rights reserved.