Combined carotid endarterectomy and coronary artery bypass grafting

RESUMO

Objective: To evaluate the perioperative and long-term outcomese of combined coronary artery bypass grafting and carotid endartectomy performed in our Institute.Methods: From January 1992 to Apri1 2004, 158 patients with a mean age of 66.3 years (range 42-81) underwent combined carotid endartectomy and coronary artery bypass grafting. Selection criteria were symptomatic ot asymptomatic 70-99 por cento carotid stenosis and unstable coronary symptoms or coronary anatomy judged to preclude safe endarterectomy. Carotid duplex scanning was introduced as a routine screening test from 1996 for patients candidate to coronary artery bypass grafting. Patients presenting fop carotid endartectomy were subjected to further cardiological study only if deemed to be at high cardiac risk. Results: Perioperative mortality was 5.7 por cento. Causes of death were myocardial infarction with multiorgan failure (four patients),irreversible left ventricular fibrillation (three patients) and low ejection syndrome complicated by stroke and ventricular fibrillation (two patients). The perioperative stroke cate was 1.3 por cento. Mean follow-up was 49 months (range 1-138) 22 patients were lost at follow-up and of remaining 136 patients 21 (15.4 por cento) died. Causes of late mortality were eight myocardial infarctions, tive cancers, six congestive heartfailure and two abdominal aortic aneurysm rupture. Late stroke rate was 2.2 por cento (two patients with contralateral stroke and one with ipsilateral stroke). One asymptomatic carotid occlusion and three [ carotid restenosis were also observed. Discussion: The low stroke cate observed in our series suggest the use of combined carotid endartectomy and coronary artery bypassgrafting in patients with significant symptomatic and asymptomatic carotid artery stenosis that need myocardial revascularization. Poor len-ventricular function, unstable angina and bilateral carotid artery stenosis, account for the high perioperative mortality associated with this approach.