ATS
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Cary W. Akins
Gus J. Vlahakes
Joren C. Madsen
Thomas E. MacGillivray
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Akins, C. W.
Right arrow Articles by Cambria, R. P.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Akins, C. W.
Right arrow Articles by Cambria, R. P.
Related Collections
Right arrow Coronary disease

Ann Thorac Surg 2005;80:2091-2097
© 2005 The Society of Thoracic Surgeons

Original article: Cardiovascular

Late Results of Combined Carotid and Coronary Surgery Using Actual Versus Actuarial Methodology

Cary W. Akins, MD a , * , Alan D. Hilgenberg, MD a , Gus J. Vlahakes, MD a , Joren C. Madsen, MD, DPhil a , Thomas E. MacGillivray, MD a , Glenn M. LaMuraglia, MD b , Richard P. Cambria, MD b

a Cardiac Surgical Unit, Massachusetts General Hospital, Boston, Massachusetts
b Vascular Surgery Division, Massachusetts General Hospital, Boston, Massachusetts

Accepted for publication May 11, 2005.

* Address correspondence to Dr Akins, Department of Surgery, White 503, Massachusetts General Hospital, 55 Fruit St, Boston, MA02114 (Email: cakins{at}partners.org).

BACKGROUND: Controversy exists over the short-term results and long-term efficacy of concomitant coronary artery bypass grafting and carotid endarterectomy. Additionally, in this population actual versus actuarial assessment of nonfatal late events has not been previously reported.

METHODS: Hospital records of 500 consecutive patients having concomitant carotid endarterectomy and coronary artery bypass grafting between 1979 and 2001 were reviewed, allowing at least 1 year of follow-up on all patients. Long-term nonfatal complications were assessed by actual and actuarial methods.

RESULTS: Patient demographics revealed a mean age of 69 years; 74% (370 patients) were male; 75% (377 patients) presented with unstable coronary syndromes; 10% (50 patients) had an intraaortic balloon pump; and 66% (329 patients) were neurologically asymptomatic. Hospital mortality was 3.6% (18 patients). Significant multivariable predictors of hospital death were preoperative transient ischemic attack or myocardial infarction, and nonelective operation. Perioperative strokes were 4.6% (23 patients), of which 2.4% (12 patients) were ipsilateral and 2.2% (11 patients) were contralateral. Significant multivariable predictors of stroke were peripheral vascular disease and use of the right internal mammary artery. Ten-year actuarial survival was 43%. Ten-year actual versus Kaplan-Meier actuarial freedoms with 95% confidence limits from late events were myocardial infarction 87% (78% and 92%) versus 81% (75% and 87%); percutaneous coronary intervention 92% (85% and 96%) versus 89% (84% and 94%); reoperative coronary grafting 96% (89% and 99%) versus 94% (90% and 98%); total stroke 85% (77% and 91%) versus 82% (76% and 87%); ipsilateral stroke 90% (83% and 94%) versus 87% (82% and 92%); carotid endarterectomy 82% (73% and 88%) versus 75% (69% and 82%).

CONCLUSIONS: Concomitant carotid and coronary artery surgery is safe and effective, particularly in preventing ipsilateral stroke, and neutralizes the impact of unilateral carotid stenosis on early and late stroke. Actual, not actuarial, methods more accurately represent the true risk of nonfatal late events.




This article has been cited by other articles:


Home page
 Card Surg AdultHome page
R. Jin and G. L. Grunkemeier
Statistical Treatment of Surgical Outcome Data
Card. Surg. Adult, January 1, 2008; 3(2008): 247 - 258.
[Full Text]

Home page
 Card Surg AdultHome page
M. L. Brown, T. M. Sundt III, and B. J. Gersh
Indications for Revascularization
Card. Surg. Adult, January 1, 2008; 3(2008): 551 - 572.
[Full Text]

Home page
 Card Surg AdultHome page
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]

Home page
 PERSPECT VASC SURG ENDOVASC THERHome page
T. A. Abbruzzese and R. P. Cambria
Contemporary Management of Carotid Stenosis: Carotid Endarterectomy Is Here to Stay
Perspectives in Vascular Surgery and Endovascular Therapy, September 1, 2007; 19(3): 248 - 256.
[Abstract] [PDF]

Home page
 Ann. Thorac. Surg.Home page
G. L. Grunkemeier, R. Jin, M. J.C. Eijkemans, and J. J.M. Takkenberg
Actual and Actuarial Probabilities of Competing Risks: Apples and Lemons
Ann. Thorac. Surg., May 1, 2007; 83(5): 1586 - 1592.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
O. S. Goksel
Combined carotid and coronary surgery: early and late results.
Ann. Thorac. Surg., October 1, 2006; 82(4): 1571 - 1572.
[Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
R. P. Cambria and C. W. Akins
Reply.
Ann. Thorac. Surg., October 1, 2006; 82(4): 1572 - 1572.
[Full Text] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 2005 by The Society of Thoracic Surgeons.