Combined surgery for cardiac and carotid disease: Management and results of a rational approach

Objectives: the aim of the present study was to apply a rational plan for s imultaneous cardiac and carotid surgery in high-risk patients. Materials and methods: a consecutive series of 89 patients with coexisting severe cardiac and carotid disease were operated on during a 5-year period with routinary carotid shunting, moderate hypothermia and balanced anaesthe sia. The combined surgical procedures were coronary artery by-pass grafts ( CABG) + carotid endarterectomy (CEA) in 81 patients, CABG + CEA + aortic va lve replacement (AVR) in four patients, and four cases of CEA + AVR. Results: two deaths (2%), three acute myocardial infarctions (3%) and orle (1%) major stroke occurred in five patients during the perioperative (30 da ys) period for a combined rate of death and/or disabling stroke of 3%. Ther e were five reversible neurological deficits. Carotid and aortic mean clamp ing times were 9 and 60 min respectively. Patients were discharged after a main length of stay in Intensive Care Unit (ICU) of 131 h and 7 days of hos pitalisation post-ICU, Conclusions: based on our results, combined interventions of CEA and CABG c an be performed with an acceptable morbidity and mortality when severe caro tid stenosis is associated with advanced, symptomatic cardiac disease. The management of these patients needs careful and appropriate pre-intra and po st-operative assessment and timing aimed to reduce the ischaemic injuries, both cardiac and cerebral, especially during CBP time.