ASSA13-08-2 Risk Factors For Simultaneous Carotid Endarterectomy and Coronary Artery Bypass Grafting

Abstract

<h3>Objectives </h3> The determination of the risk factors of neurological complications for simultaneous carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG) and the ways to reduce them. <h3>Methods</h3> 7568 patients (mean age 61.3 ± 7.3, men prevailed) underwent CABG during the period 2003 – 2010. Simultaneous surgical procedures (SSP) - CEA + CABG were performed in 229 (3.0%) cases. In all patients CEA was performed as the first stage, CABG as the next one. The present research consists of 2 parts: retrospective analysis of 123 SSP and prospective evaluation of 106 SSP. <h3>Results</h3> 229 SSP (CEA + CABG) were performed using cardiopulmonary bypass (CB) and warm blood cardioplegia. Mean duration of surgery was 287 ± 41min, CB – 96 ± 27 min, anoxia – 61 ± 27 min, carotid cross-clamping – 13.3 ± 3.5 min. Performing SSP at first we registered a considerable rate of neurological complications in patients with bilateral carotid disease: ischemic stroke – 11.2%, mortality rate – 5.8%. The retrospective multivariate logit regression analysis of the results of 123 SSP detected the following risk factors for ischemic stroke: contralateral stenosis of internal carotid artery (ICA) &gt; 75% (p = 0.049), system hypothermia (rectal temperature) &gt; 29 °C (p = 0.031). Consequently, since 2010 we changed the surgical approach in patients with combined coronary and carotid disease. Thus, patients with contralateral stenosis of ICA &gt; 75% undergo surgery in system hypothermia with &lt; 29 °C. In the prospective part of the analysis of 106 SSP 2 groups were reviewed: group 1 – 57 (53.7%) patients with bilateral stenosis of ICA &gt; 75%; group 2 – 49 (46.3%) patients with unilateral stenosis of ICA &gt; 75%.In group 1 stroke was registered in 1.75%, mortality rate was 1.75%. In group 2 stroke was observed in 2%, mortality rate was 2%. <h3>Conclusions</h3> The risk factors for ischemic stroke for SSP (CEA + CABG) are contralateral stenosis of ICA &gt; 75%, system hypothermia (rectal temperature) &gt; 29 °C. The use of hypothermic perfusion on the CEA phase of SSP in patients with bilateral stenosis of ICA &gt; 75% effectively reduces neurological complications (9 times less), stroke rate (6.5 times less (p = 0.047)), mortality rate (3 times less (p = 0.3)).