Routine preoperative carotid duplex scanning in patients undergoing open heart surgery: Is it worthwhile?

It has been reported that carotid screening may be cost-effective in patien t populations in which the prevalence of severe carotid stenosis exceeds 4. 5%. In order to identify potential patient populations who might benefit fr om carotid screening, we examined the results of preoperative duplex scanni ng in patients undergoing open heart surgery. Between January 1995 and July 1998, 3708 patients (59% male, 41% female) underwent open heart surgery at our institution. Of these, 3081 underwent coronary artery bypass grafting (CABG), 364 underwent valve replacement (VR), and 263 underwent CABG and VR . The ages of these patients ranged from 40 years to 98 years (mean 68 +/- 11 years). The risk factors analyzed included hypertension (HTN), 59%; smok ing (Smk), 53%; and diabetes (DM), 33%. Patients were divided into three gr oups according to their age. Group A consisted of the 835 patients who were less than or equal to 60 years old, group B consisted of 2474 patients ran ging from 61 years to 80 years old, and group C consisted of 399 patients w ho were greater than or equal to 81 years old. All patients underwent bilat eral preoperative carotid duplex scans at an Intersocietal Commission for t he Accreditation of Vascular Laboratories (ICAVL)accredited vascular labora tory. Statistical analyses were performed using chi-squared, Fisher's exact test, linear regression, and multivariate analysis. From our results we co ncluded that carotid screening is not recommended for patients under 60 yea rs of age who are undergoing CABG unless they present with a minimum of two of the following major risk factors: hypertension, diabetes, or smoking. H owever, carotid screening is recommended for all patients undergoing open h eart operations who are over the age of 60 years old, regardless of the abs ence of associated risk factors.