CARDIAC EVENTS AFTER COMBINED SURGERY FOR CORONARY AND CAROTID-ARTERYDISEASE

Objective: To evaluate serious cardiac events after combined (either s ingle or two stage) coronary artery surgery (CAS) and carotid endarter ectomy (CEA) for concomitant coronary and carotid artery disease. Meth ods: We have analyzed our 15 year experience (January 1981-September 1 996) with 201 consecutive patients operated on using both approaches. Group A consisted of 48 patients with the single-stage procedure, whil e in group B (153 patients), two stage procedure was carried out, eith er as carotid endarterectomy (CEA), followed by coronary artery bypass surgery (CAS) (group B-1 103 patients), or as CAS followed by CEA (gr oup B-2(-) 50 patients). Five patients from B-1 group died after the C EA procedure, but were included, despite the fact they never reached t he second stage. Left main coronary artery disease was found in 41 pat ients (20.4%), poor left ventricular function in 49 (24.4%) previous M I in 133 (66.2%), while 136 (67.7%) were in NYHA functional class III or IV. Bilateral carotid involvement was present in 61 patients (30.3% ). Unstable angina was more prevalent in groups A and B-2 (P < 0.0001) , NYHA class III/IV in group A (versus B-1, P = 0.001 and versus B-2 P = 0.02), low ejection fraction in groups A and B-2 (P < 0.0001), bila teral carotid stenosis in group B-1 (versus A, P = 0.003 and versus B- 2, P < 0.0001), and ulcerated plaque in group B-1 (P < 0.0001). These differences dictated the surgical strategy, which resulted in differen t protocols for clinical and operative management. Results: Early mort ality for the entire group was 5.5% (11/201) 6.2% in group A, 7.8% in group B-1 and 0% in group B-2, respectively; (P > 0.05). Serious morbi dity occurred in 7.5% of patients (8.3% in group A, 7.8% in group B-1 and 6% in group B-2, respectively: P > 0.05). Univariate analysis reve aled only bilateral carotid stenosis to influence early outcome (P = 0 .04). Conclusion: Patients with concomitant coronary and carotid arter y disease have relatively good immediate operative results. providing all existing lesions are corrected. Despite it did not reach the stati stical significance, cardiac events were less frequent in groups A and B-2 indicating possible protective effect of prior CAS in patients wi th concomitant disease. (C) 1997 Elsevier Science B.V.