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Ann Thorac Surg 2006;82:1571-1572
© 2006 The Society of Thoracic Surgeons

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Correspondence

Combined Carotid and Coronary Surgery: Early and Late Results

Department of Cardiovascular Surgery, University of Istanbul, Istanbul Medical Faculty, 4. Gazeteciler Sitesi, C3 Blok, Da: 16, Levent, Istanbul, 80620 1 Turkey

(Email: onurgokseljet{at}gmail.com).

To the Editor:

We read with greatest interest the article by Akins and coworkers [1] on the early and late outcomes after concomitant carotid and coronary surgery. They analyzed their results with 500 consecutive patients who underwent simultaneous carotid and coronary surgery for a 22-year period. We would like to congratulate the authors for their favorable results with an overall in-hospital stroke rate of 4.6%. Our group recently reported an 8-year experience with 82 patients who had a perioperative stroke incidence of 4.8% [2]. It was interesting to compare our results with the analysis performed by Akins and coworkers [1]. They noted that the majority of strokes occurred during the combined procedure with a single anesthetic rather than postoperatively (3.4% vs 1.2%). However, it was not possible for the reader to discriminate whether the adverse neurologic events resulted from the carotid or the coronary procedure, which have their own morbidity factors. To assess and overcome this problem, we modified our technique in 1998 to use locoregional cervical block for carotid endarterectomy rather than a single anesthetic period as the authors used. Regarding our relatively smaller cohort of 44 patients in 5 years, this modified technique allowed a secondary benefit of a gross estimation of the neurologic insult. Akins and coworkers [1] report as high as 52% carotid shunting rate; however, the modified technique by design allows the surgeon to monitor the patients' neurologic status and take the necessary precautions selectively. In our modified group, our shunting rate was 6.8% [2]. In earlier reports, shunting rate even in high-risk patients with contralateral occlusion and stenosis was 10.9% [3]. Selective shunting minimizes the risk of mechanical trauma to atherosclerotic carotid vessels, thus allowing the surgeon to surgically repair the thrombosis or occlusion of the carotid artery by an elevated plaque. Akins and coworkers [1] may argue that these are not common complications; but we believe that they do happen and are more likely to happen in the setting of a frequent shunt use. In our series the mean follow-up for 82 patients who underwent a concomitant procedure was 59.59 ± 29.68 months, and actuarial 10-year survival for the modified group was 94.44%, with a standard error of the mean of 3.83 [2].

We would also like to congratulate the authors for showing the keen reader a new concept for the statistical approach to compare the actual with the actuarial estimates.

	References

Top References

 

1. Akins CW, Hildenberg AD, Vlahakes GJ, et al. Late results of combined carotid and coronary surgery using actuarial methodology Ann Thorac Surg 2005;80:2091-2097.[Abstract/Free Full Text]
2. Cinar B, Goksel OS, Kut S, et al. A modified combined approach to operative carotid and coronary artery disease: 82 cases in 8 years The Heart Surg Forum 2005;8:184-189.
3. Cinar B, Goksel OS, Karatepe C, et al. Is routine intravascular shunting necessary for carotid endarterectomy in patients with contralateral occlusion? A review of 5-year experience of carotid endarterectomy with local anesthesia. Eur J Vasc Endovasc Surg 2004;28:494-499.

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

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted 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): Onur S. Goksel Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Goksel, O. S. Search for Related Content PubMed PubMed Citation Articles by Goksel, O. S. Related Collections Coronary disease Related Article