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Harpreet Wasir
Vijay Kohli
Zile Singh Meharwal
Rajneesh Malhotra
Yatin Mehta
Naresh Trehan
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Ann Thorac Surg 2004;78:2037-2042
© 2004 The Society of Thoracic Surgeons

Original Article: Cardiovascular

Concomitant Carotid Endarterectomy and Coronary Bypass Surgery: Outcome of On-Pump and Off-Pump Techniques

Yugal Mishra, PhDa,*, Harpreet Wasir, MCha, Vijay Kohli, MCha, Zile Singh Meharwal, MCha, Rajneesh Malhotra, MCha, Yatin Mehta, MDb, Naresh Trehan, MDa

a Department of Cardiovascular Surgery, Escorts Heart Institute and Research Centre, New Delhi, India
b Department of Cardiovascular Anaesthesiology, Escorts Heart Institute and Research Centre, New Delhi, India

Accepted for publication June 2, 2004.

* Address reprint requests to Dr Mishra, Escorts Heart Institute and Research Centre, New Delhi, India (E-mail: dryugal{at}yahoo.com).

BACKGROUND: There continues to be a dilemma regarding the best means of surgical management of significant carotid artery disease in patients requiring coronary artery bypass surgery. A combined approach of coronary artery bypass and carotid endarterectomy has shown good results in patients with concomitant carotid and coronary artery disease. We reviewed our results of coronary artery surgery using conventional cardiopulmonary bypass or off-pump techniques and carotid endarterectomy done as a combined procedure.

METHODS: Between January 1996 and June 2002, 358 patients underwent concomitant coronary artery bypass and carotid endarterectomy. There were 140 males (84.3%) and 26 females (15.7%) in group I. Group II consisted of 158 males (82.3%) and 34 females (17.7%). One hundred sixty-six patients (group I) were done off pump whereas in 192 patients (group II), the procedure was done using conventional cardiopulmonary bypass. Carotid endarterectomy was performed before coronary artery bypass surgery in both groups.

RESULTS: The average number of grafts were 3.4 ± 0.8 with average operative time of 4.2 ± 0.4 hours in group I, and 3.3 ± 0.8 graft with operative time of 5.3 ± 1.2 hours in group II (p = 0.239 and p < 0.001, respectively). There were 2 deaths (1.2%) in group I and 3 deaths (1.6%) in group II (p = 0.870). No patient from group I and 1 patient (0.5%) from group II had postoperative stroke (p = 0.941). Mean hospital stay was 9.0 ± 1.2 days in group I and 11.2 ± 1.7days in group II (p < 0.001). At mean follow-up of 2.8 ± 0.9 years in group I, 2 patients (1.2%) had late death due to cardiac failure and contralateral carotid endarterectomy was done in 2 patients (1.2%). Group II had mean follow-up of 2.4 ± 0.6 years, during which 4 patients (2.1%) had late death and contralateral carotid endarterectomy was done in 3 patients (1.6%). Late stroke was seen in 1 patient (0.6%) from group I and 2 patients (1.0%) from group II.

CONCLUSIONS: Concomitant carotid endarterectomy and coronary artery bypass is a safe and effective procedure in patients with significant coronary and carotid artery disease. Equally good results can be reproduced using cardiopulmonary bypass or off-pump techniques for coronary artery surgery, with low morbidity, mortality, and good long-term results.


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INVITED COMMENTARY
Michael A. Borger
Ann. Thorac. Surg. 2004 78: 2042-2043. [Extract] [Full Text] [PDF]



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L. Barandon, P. Richebe, E. Munos, J. Calderon, M. Lafitte, S. Lafitte, T. Couffinhal, and X. Roques
Off-pump coronary artery bypass surgery in very high-risk patients: adjustment and preliminary results
Interactive CardioVascular and Thoracic Surgery, October 1, 2008; 7(5): 789 - 793.
[Abstract] [Full Text] [PDF]


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