Ann Thorac Surg 2002;73:797
© 2002 The Society of Thoracic Surgeons
Invited commentary
David A. Fullerton, MDa
a Division of Cardiothoracic Surgery Northwestern University Medical School 201 E Huron St, Ste 10-105 Chicago, IL 60611, USA
e-mail: dfullert{at}nmh.org
Patients with a combination of carotid and coronary arterial disease present a vexing problem. Upon recognizing that operating on both arterial beds under the same anesthesia may pose a greater risk of stroke, of perioperative myocardial infarction, and of death, most surgical programs adopted an algorithm in which the most symptomatic vascular bed was operated on first. Typically this meant performing a carotid endarterectomy a few days prior to coronary bypass surgery. Such a strategy has proved safe and has produced excellent results.
It has long been considered that one of the potential risk factors for stroke in such patients is the use of cardiopulmonary bypass. Hence, applying off-pump techniques to these patients intuitively offers the advantage of avoiding cardiopulmonary bypass and possibly eliminating one potential cause of stroke. By employing that strategy, Dr Meharwal and colleagues have achieved a truly enviable surgical result. Building upon their huge off-pump experience—more than 2,500 cases in four years—the authors in this report emphasize the potential advantage of conducting carotid endarterectomy followed by off-pump coronary bypass surgery under the same anesthetic. As the study would suggest, surgeons experienced with off-pump techniques should strongly consider this approach to patients who have combined carotid and coronary arterial disease.
Related Article
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Safety and efficacy of one stage off-pump coronary artery operation and carotid endarterectomy
- Zile Singh Meharwal, Anil Mishra, and Naresh Trehan
Ann. Thorac. Surg. 2002 73: 793-797.
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