HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Anoar Zacharias Thomas A. Schwann Christopher J. Riordan Samuel J. Durham Milo Engoren Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Zacharias, A. Articles by Habib, R. H. Search for Related Content PubMed PubMed Citation Articles by Zacharias, A. Articles by Habib, R. H. Related Collections Coronary disease Related Article

Ann Thorac Surg 2002;73:491-497
© 2002 The Society of Thoracic Surgeons

---

Original article: cardiovascular

Operative and 5-year outcomes of combined carotid and coronary revascularization: review of a large contemporary experience

^a Department of Cardiovascular Surgery, St. Vincent Mercy Medical Center, Toledo, Ohio, USA
^b Department of Vascular Surgery, St. Vincent Mercy Medical Center, Toledo, Ohio, USA
^c Department of Anesthesia, St. Vincent Mercy Medical Center, Toledo, Ohio, USA
^d Department of Surgery, Medical College of Ohio, Toledo, Ohio, USA

Accepted for publication October 15, 2001.

* Address reprint requests to Dr Habib, Cardiopulmonary Research, St. Vincent Mercy Medical Center, 2213 Cherry St, ACC Bldg, Suite 309, Toledo, OH 43608, USA
e-mail: robert_habib{at}mhsnr.org

Background. Surgical treatment of concomitant coronary and carotid disease is controversial. Studies comparing staged versus combined coronary artery bypass grafting and carotid endarterectomy (CABG/CEA) report varying and often conflicting operative results. Also, few studies have investigated the long-term outcomes of combined surgery.

Methods. We reviewed the operative outcome and 5-year survival results of 189 consecutive patients (69 ± 9 years old, 66 [35%] female patients) who underwent combined CABG/CEA between 1994 and 1999. Survival follow-up was conducted in February 2001 and the incidence of late stroke, carotid surgery, and myocardial infarction was investigated in all surviving patients by mail survey. A phone interview was done by a surgeon of patients with late strokes or repeated CEA.

Results. Operative death occurred in 5 of 189 patients (2.65%) 4 of which were in-hospital deaths. A total of 5 (2 permanent, 3 transient [2.65%]) perioperative strokes were documented in these patients, and 1 of the perioperative strokes patients died in the hospital. In all, 156 of 189 patients (82.5%) were alive at the time of the study and completed surveys were collected from 153 of 156 patients (98%). Of these 153 patients, 4 reported a late stroke (2.6%), 5 suffered a myocardial infarction (3.3%), and 16 (10.5%) underwent subsequent CEA (7 ipsilateral to original CEA). Angioplasty (3 of 153, 2.0%) and redo surgery (1 of 153, 0.66%) occurred infrequently. Median survival follow-up was 51 months (range 12 to 84), and the corresponding 5-year Kaplan-Meier survival was 79.4%. This survival was similar to that of age-matched isolated CABG patients (n = 532) with documented history of cerebrovascular disease but no surgical carotid lesions.

Conclusions. Our results suggest that combined CABG/CEA is safe and may in fact reduce the risk of adverse outcomes in the intermediate term compared with age and risk-matched patients. We speculate the latter may be attributable to a cerebrovascular protective effect of CABG/CEA pending verification by randomized trials. An economic benefit of CABG/CEA may also be inferred from avoiding separate coronary and carotid operations and reduction in the high costs of perioperative stroke.

Related Article

Invited commentary

Cary W. Akins
Ann. Thorac. Surg. 2002 73: 497-498. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

				C. W. Akins and R. P. Cambria Myocardial Revascularization with Carotid Artery Disease Card. Surg. Adult, January 1, 2008; 3(2008): 655 - 668. [Full Text]

				N. Hudorovic Reduction in hospitalisation rates following simultaneous carotid endarterectomy and coronary artery bypass grafting; experience from a single centre Interactive CardioVascular and Thoracic Surgery, August 1, 2006; 5(4): 367 - 372. [Abstract] [Full Text] [PDF]

				L. Nwakanma, H. K. Poonyagariyagorn, R. Bello, A. Khoynezhad, D. Smego, and K. A. Plestis Early and late results of combined carotid endarterectomy and coronary artery bypass versus isolated coronary artery bypass Interactive CardioVascular and Thoracic Surgery, April 1, 2006; 5(2): 159 - 165. [Abstract] [Full Text] [PDF]

				P. H. Kolh, L. Comte, V. Tchana-Sato, C. Honore, A. Kerzmann, M. Mauer, and R. Limet Concurrent coronary and carotid artery surgery: factors influencing perioperative outcome and long-term results Eur. Heart J., January 1, 2006; 27(1): 49 - 56. [Abstract] [Full Text] [PDF]