Simultaneous carotid endarterectomy and coronary revascularization

Background. Combined cardiac operation and carotid endarterectomy using our technique is an acceptable approach to simultaneous correction of both car otid and cardiac disease. Methods. From August 1989 to March 1998, 121 consecutive patients underwent combined operations. Of these patients, 112 had coronary artery bypass gra fting and carotid endarterectomy, and 9 had coronary artery bypass grafting , carotid endarterectomy, and valve repair or replacement. All patients had a critical stenosis of 85% or more of the carotid artery. Mean age of the patients was 69.2 years; 80 patients were 65 years old or older. There were 88 men and 33 women. Notable risk factors included chronic obstructive pul monary disease (19.8%), congestive heart failure (28%), preoperative myocar dial infarction and unstable angina (66.9%). Of the patients, 20.7% had a s tenosis of greater than 50% of the left main coronary artery. The technique used was correction of both the carotid and coronary lesions during a sing le aortic cross-clamp period using retrograde continuous blood cardioplegia for myocardial protection. Systemic hypothermia to 25 degrees C was used f or cerebral protection. Results. Mean cross-clamp time was 118 minutes. Seven patients (5.8%) susta ined perioperative cerebrovascular accidents. Two patients had transient is chemic attacks. The procedure-related mortality rate was 5.8%. Conclusions. The described technique is a good method for simultaneous repa ir of coronary and carotid lesions in a high-risk group of patients with co ncomitant disease. We will continue to use it. (C) 2000 by The Society of T horacic Surgeons.