gms | German Medical Science

Introduction: The occurence of severe carotid artery disease in more than 12% of patients requiering CABG results in a discrepany concerning best treatment for both diseases. We reviewed the early outcome of patients with CABG and / or valve replacement and simultaneous carotid endarterectomy (CEA).

Materials and methods: We retrospectiveley evaluated 386 pts operated simultaneously between 7/ 1993 and 4/ 2010.326 pts received isolated CABG, 56 CABG and / or valve replacement, 4 aortic surgery. Mean age was 68.3 years (range 45 to 87). 229 pts were males. 34% showed preoperatively symptomatic carotid stenosis ( mostly TIA or Amaurosis fugax). Lesion at operated side was 70-80% in 167 pts, 80-99% in 219 pts. 164 pts (42%) showed bilateral carotid stenosis, 56 of them > 80%, 32 pts had contralateral occlusion. 14% were urgent operations. We analyzed risk factors, morbidity, incidence of neurological events and 30-day mortality.

Results: Perioperative stroke with hemiplegia occured in 2.6% ( 10 pts).4 of them showed contralateral occlusion, 3 contralateral severe stenosis, 0.7% (3pts) experienced PRIND, 1.8% ( 7 pts) TIA. 30-day mortality was 5.2%. 8 deaths were cardiac related, 10 due to extracardial reasons, 3 pts developped a cerebral death.

Conclusion: Simultaneous CEA and Cardiac Surgery can be performed with a low risk for neurological complications (superior to the recommended guidlines) and acceptable mortality.Occlusion of contralateral carotid artey could be identified as an evident predictor for increased neurological complications.