Long-term results of simultaneous carotid endarterectomy and myocardial revascularization with cardiopulmonary bypass used for both procedures

Objective: Controversy continues about the treatment of patients with a con comitant occlusive disease of the coronary and carotid arteries. Our operat ive strategy in these patients is to do simultaneous carotid endarterectomy and myocardial revascularization in conjunction with cardiopulmonary bypas s with mild hypothermia. We report our experience with this kind of one-sta ge procedure and its retrospective long-term results. Methods: From February 1985 to September 1998, 340 patients underwent simul taneous carotid endarterectomy and myocardial revascularization. The averag e age of the patients was 65.3 years; 45.6% were neurologically symptomatic , and 44.4% had bilateral carotid stenosis. The indication for carotid enda rterectomy was lumen diameter reduction of mon than 75%, angiographic signs of thrombogenic endovascular morphology, or both. Carotid endarterectomy w as performed in conjunction with cardiopulmonary bypass with mild hypotherm ia, hemodilution, systemic heparinization, and controlled hemodynamics unde r pulsatile perfusion for additional cerebral protection. Results: There were 16 perioperative neurologic complications (4.7%), 11 pe rmanent deficits (3.2%), and 9 cardiac complications (2.6%). Early mortalit y was 2.6% (SE 0.8%): 2 patients had a stroke and 2 had a myocardial infarc tion. The 5-year survival was 78.9% (SE 2.6%). and freedom from ipsilateral stroke and cardiac event were 93,2% (SE 1.5%) and 87.5% (SE 2.1%), respect ively. The predictor for early death was age over 70 years, and predictors for late death were age over 70 years, previous myocardial infarction, prev ious stroke, and bilateral carotid stenosis of greater than 90%. Conclusion: On the basis of our long-term results, we believe that simultan eous carotid endarterectomy and myocardial revascularization in conjunction with cardiopulmonary bypass is a method safe: enough to prefer its routine use with acceptable low operative risk and satisfactory Lung-term morbidit y.