Original Article
Early results of simultaneous carotid endarterectomy and offpump coronary artery bypass grafting: experience from a single center
Abstract
Background: The optimal management of patients with concomitant carotid and coronary artery disease remains controversial.
Methods: The records of 113 consecutive patients who underwent either simultaneous carotid endarterectomy (CEA) and off-pump coronary artery bypass grafting (CABG) (CEA/CABG, n=15) or offpump CABG alone (CABG, n=98) between January 2013 and July 2015 were reviewed. We retrospectively analyzed the baseline characteristics and 30-day results of both groups.
Results: The two groups were similar with regard to age, gender, hypertension, diabetes mellitus, hyperlipidemia, smoking, chronic renal failure, prior MI, previous PCI, ejection fraction, LM or triplevessel disease, stable and unstable angina. Peripheral vascular disease was more prevalent in the CEA/CABG group (53.3% vs. 6.1%, P<0.001). History of a prior stroke was also more common in CEA/CABG group (60% vs. 24.5%, P<0.01). The intraoperative blood loss was 780.0±352.9 mL in the CEA/CABG group and 415.3±152.7 mL in the CABG group (P<0.001). The total operating time was 295.3±49.7 min in the CEA/ CABG group and 212.9±35.0 min in the CABG group (P<0.001). The rest of the intraoperative variables were not statistically different between the two groups (all P>0.05). No death within 30 days occurred in both groups. There was no significant different between the two groups in postoperative complications [stroke, myocardial infarction (MI), transient ischemic attack (TIA), atrial fibrillation/atrial flutter, cardiac tamponade, cardiac arrest, pulmonary infection, Wound infection, and bleeding requiring re-operation] (all P>0.05). The cumulative complications at 30 days was 3 (20%) in the CEA/CABG group compared with 16 (16.3%) in the CABG group (P=0.72). The differences in total intubation time, intensive care unit (ICU) stay and hospital stay were also not statistically significant (all P>0.05).
Conclusions: Our results showed that addition of CEA to CABG would not increase the risk of mortality and morbidity relative to patients underwent CABG alone. Our study adds to the controversy of simultaneous CEA/CABG procedure. Large-scale, multi-center, randomized clinical trials are required to further evaluate the outcomes of simultaneous CEA/CABG.
Methods: The records of 113 consecutive patients who underwent either simultaneous carotid endarterectomy (CEA) and off-pump coronary artery bypass grafting (CABG) (CEA/CABG, n=15) or offpump CABG alone (CABG, n=98) between January 2013 and July 2015 were reviewed. We retrospectively analyzed the baseline characteristics and 30-day results of both groups.
Results: The two groups were similar with regard to age, gender, hypertension, diabetes mellitus, hyperlipidemia, smoking, chronic renal failure, prior MI, previous PCI, ejection fraction, LM or triplevessel disease, stable and unstable angina. Peripheral vascular disease was more prevalent in the CEA/CABG group (53.3% vs. 6.1%, P<0.001). History of a prior stroke was also more common in CEA/CABG group (60% vs. 24.5%, P<0.01). The intraoperative blood loss was 780.0±352.9 mL in the CEA/CABG group and 415.3±152.7 mL in the CABG group (P<0.001). The total operating time was 295.3±49.7 min in the CEA/ CABG group and 212.9±35.0 min in the CABG group (P<0.001). The rest of the intraoperative variables were not statistically different between the two groups (all P>0.05). No death within 30 days occurred in both groups. There was no significant different between the two groups in postoperative complications [stroke, myocardial infarction (MI), transient ischemic attack (TIA), atrial fibrillation/atrial flutter, cardiac tamponade, cardiac arrest, pulmonary infection, Wound infection, and bleeding requiring re-operation] (all P>0.05). The cumulative complications at 30 days was 3 (20%) in the CEA/CABG group compared with 16 (16.3%) in the CABG group (P=0.72). The differences in total intubation time, intensive care unit (ICU) stay and hospital stay were also not statistically significant (all P>0.05).
Conclusions: Our results showed that addition of CEA to CABG would not increase the risk of mortality and morbidity relative to patients underwent CABG alone. Our study adds to the controversy of simultaneous CEA/CABG procedure. Large-scale, multi-center, randomized clinical trials are required to further evaluate the outcomes of simultaneous CEA/CABG.
