Artery Bypass Grafting Procedures Research Articles

Abstract 11842: Graft Flushing Solution Applies Myocardial Protection Properties in Coronary Artery Bypass Grafting

Introduction: In on-pump coronary artery bypass grafting (CABG) procedures testing of the distal anastomoses via repeated flushing of graft storage solution perfuses at a certain extent the downstream myocardium. This study evaluated the impact of specific solutions on myocardial protection during CABG procedures. Hypothesis: Duragraft® (Somaluthion, Jupiter FL,USA) storage solution exhibits beneficial myocardial protection compared to 0.9% Saline/Biseko® (Biotest Pharma GmbH, Dreieich, Germany). Methods: Between 7/2019 - 3/2020 either Duragraft® (Group A) or 0.9% Saline/Biseko (Group B) was applied during 272 CABG procedures. After propensity matching 166 patients of identical group size (male: 86.7%; 68.1 ± 9.3 years) were analyzed in this single center retrospective study. Cardiac enzymes were evaluated after CABG during hospital stay and compared between both groups. Results: The mean count of venous and overall grafts was 1.5 (± 0.5) and 2.6 (±0.7). No clear difference in the distribution pattern of Creatine Kinase was observed, while high sensitive Troponin I (in nanogram per liter) were significantly lower in Group A at 12-24 hours (4384.9 (± 5509.6) vs. 11566.9 (± 31505,1); p= 0.042), two days (1931.9 (± 3079.8) vs. 4978.5 (± 9145.6); p= 0.05), three days (1473.3 (± 3207.4) vs. 2939.8 (±5564.5); p= 0.046) four days (992.4 (± 1957.3) vs. 1995 (± 3404.8); p= 0.037) and at the sixth day (716.3 (± 1056,2) vs. 1573.9 (±3013.1); p= 0.046) after surgery. Conclusions: Downstream myocardium perfusion with graft solution could provide enhanced myocardial protection in on-pump procedures, with Duragraft® being superior to Saline/Biseko® in terms of Troponin release.

Comparing outcomes of transcatheter versus surgical aortic valve replacement in patients with atrial arrythmias

Abstract Introduction In patients with severe aortic valve stenosis, clinical trials have demonstrated a similar mortality risk with transcatheter aortic valve replacement (TAVR) compared to surgical aortic valve replacement (SAVR) in low to intermediate-risk patients. However, data comparing these procedures in patients with atrial arrhythmias is lacking. Purpose This study aimed to evaluate and compare the in-hospital mortality and outcomes of TAVR and SAVR for severe aortic stenosis in patients with atrial fibrillation or atrial flutter. Methods We performed a retrospective cross-sectional analysis using the 2018 National Inpatient Sample. Patients aged 50 years and older with TAVR or SAVR related hospitalizations were identified. Patients with endocarditis and those undergoing coronary artery bypass grafting or other valvular procedures were excluded. Propensity score matching was utilized to mitigate selection bias. The scoring was based on a multivariate logistic regression model accounting for age, gender, race, hospital type, hospital region, hospital teaching status, median household income, and medical comorbidities. Using 8-to-1-digit match, we paired each admission in TAVR group with one admission in SAVR group. Results In 2018, a total of 3487 TAVRs and 1466 SAVRs were performed in patients who had atrial fibrillation or atrial flutter. TAVR and SAVR had no statistically significant difference in inpatient mortality (0.9% vs 0.8%, p=0.79). However, SAVR was associated with higher odds of cardiogenic shock (OR 1.82; 95% CI 1.41–2.35, p<0.0001), acute kidney injury (OR 2.29; 95% CI 1.77–2.97, p<0.0001), mechanical ventilation (OR 2.06; 95% CI 1.75–2.43, p<0.0001), pneumonia (OR 1.76; 95% CI 1.37–2.28, p<0.0001), pneumothorax (OR 6.38; 95% CI 4.17–9.76, p<0.0001) and postoperative hemorrhage (OR 3.21; 95% CI 2.13–4.85, p<0.0001). On the contrary, SAVR was associated with decreased likelihood of subsequent cardiac conduction disorders (OR 0.63; 95% CI 0.51–0.79, p<0.0001) and pacemaker implantation (OR 0.69; 95% CI 0.49–0.98, p=0.037). SAVR was associated with an increased length of hospitalization (3.9 vs. 8.4 days, p<0.0001), with no difference in medical costs. Conclusion Inpatient mortality for TAVR and SAVR was similar in patients with atrial fibrillation and atrial flutter. TAVR was associated with a lower risk of inpatient complications, indicating greater suitability for high-risk patients. However, clinicians should be cognizant of the increased risk for cardiac conduction disorders after TAVR, necessitating pacemaker implantation. Funding Acknowledgement Type of funding sources: None. Characteristics of the matched cohortForest plot comparing outcomes

Stroke Rates Following Surgical Versus Percutaneous Revascularization for Ischemic Heart Disease.

Coronary revascularization is a commonly performed major procedure in the hospitals. Stroke is one of the dreaded complications after coronary revascularization procedures. The focus of this review is to understand the stroke risk in percutaneous cutaneous intervention (PCI) and coronary artery bypass grafting (CABG) procedures. Available data show that PCI offers less procedural stroke risk compared to CABG although the survival benefits of CABG are better in certain scenarios. Innovative advancements in techniques, pre-procedural optimum medical therapy (OMT), intraoperative neuro-monitoring, and multidisciplinary post procedural care are the few strategies in early detection and reduce stroke risk. Despite several innovations and strategies, it is evident that there is not enough data available to make concrete conclusions related to stroke risk after coronary revascularization, which warrants further investigation.

Trends in per-operative parameters and postoperative complications associated with coronary artery bypass graft surgery (CABG); A four-year retrospective study

Objective:To determine the patterns of per-operative parameters and early outcomes of patients that underwent CABG surgery during a four-year period.Methods:This is a cross-sectional descriptive study conducted in a tertiary care of hospital from November 2020 to January 2021. All the patients that underwent the isolated coronary artery bypass grafting (CABG) procedure were included in the study from June 2017 till June 2020. Data was collected on a data extraction form and stored in SPSS format which was analyzed for qualitative statistics keeping p<0.05 as significant. All the results were represented in the form of tables.Results:A total of 1,613 patients were operated upon for Coronary Artery Bypass Grafting (CABG) procedure during the study period with 1,222 (75.8%) males and 391 (24.2%) females. Dyslipidemia (71.8%) was the most common risk factor. The average perfusion time decreased only slightly (~1 minute) from 96.01 minutes to 95.07 minutes (2017 to 2020). This change however was not significant (p=0.301). The rate of Left Internal Mammary Artery (LIMA) use stayed relatively stable over the 4-year period fluctuating between 88.7% and 92.9% (p=0.360). The average initial ICU stay (in hours), drain at 12 hours and 24 hours stays almost the same. The rate of mortality peaked in 2018 (4.76%) and subsequently fell to 3.57% by 2020.Conclusion:More males underwent CABG surgery at this tertiary care hospital and the overall complication rate and per-operative parameters improved over the years. The non-risk stratified mortality in this study was found to be higher than developed nations.

Lower Mini-Sternotomy: a New Approach for Minimally Coronary Artery Bypass Surgery: Chances and Limitations of a New Technology

Background The rate of Coronary Artery Bypass Grafting (CABG) procedures decreased generally over the past years while the relative number of off-pump coronary artery bypass grafting (OPCAB) procedures remained stable. OPCAB can be performed in different ways also using a minimally invasive direct approach (MIDCAB). This technique consists usually of the approach through the Left Anterior Small Thoracotomy (LAST) and is in principle limited for single LAD revascularization only. Lower Mini-Sternotomy (LOMS) is an optimization of the minimal-invasive approach permitting the harvest of both internal thoracic arteries (ITA) as well as excellent exposure and immobilization of the left and right coronary arteries. Methods Between January 2016 and June 2017 LOMS was performed in 31 patients to achieve access to the left and right internal thoracic arteries and to reach the left anterior descending coronary artery, diagonal branches, and right coronary artery for off-pump, all-arterial, aortic no-touch revascularization. Postoperative pain intensity was assessed on a daily basis for 7 days and patients were followed prospectively after operation at our outpatient clinic on a monthly basis in order to assess the incidence of complications. Results The mean operative time was 163 ± 49 minutes (range 119 to 260 minutes). The mean length of the skin incision was 7.4 ± 1.3 cm (range 6 to 11 cm). Neither hemodynamic changes nor transient S-T segment changes on the ECG occurred during the operation. In most patients, recovery was rapid and uneventful. No hospital death or morbidity was observed. No blood transfusion was required perioperatively. There were no perioperative neurological cognitive dysfunction events. Maximal pain levels were registered on postoperative day 2 or 3, and pain had abated in most patients on day 5. At follow-up, all patients were in New York Heart Association class I. Conclusions Despite more demanding surgical technique than with full-sternotomy OPCAB, our experience demonstrates that the LOMS for MIDCAB is a technically feasible procedure for myocardial revascularization. Not only the LAD and its branches but also the RCA and can be used safely with very good procedural outcomes.

Understanding the Breadth and Depth of C-L Psychiatry: Decisional Capacity Assessments

Understanding the Breadth and Depth of C-L Psychiatry: Decisional Capacity Assessments

Abstract 171: User Beware: Understanding the Adjusted Estimates of Propensity Score Methods

Background: Propensity score methods are used in observational studies to compensate for the lack of random allocation by balancing measured baseline characteristics between treated and untreated patients. Yet default implementations of propensity score methods may lead to contradictory findings. Our goal was to illustrate differences in treatment effect estimates produced using propensity score methods such as matching and inverse probability weighting (IPW). Methods: We used data from a retrospective analysis of the Northern New England Cardiovascular Disease Study Group registry that studied reintervention after single internal mammary artery (SIMA) versus bilateral internal mammary artery (BIMA) conduit use in 41,481 coronary artery bypass grafting (CABG) procedures from 1992-2014. Results: The mean duration of follow-up was 13.2 (IQR: 7.4-17.7) years. In our standard multivariable Cox regression analysis, the adjusted HR for reintervention was 0.83 (95% confidence interval (CI): 0.75-0.92) in patients receiving BIMA compared to SIMA (Table). The 1:1 propensity matched analysis (HR=0.79, 95% CI: 0.69-0.91) and IPW estimate among the treated (HR=0.83, 95% CI: 0.75-0.92) show a similar protective treatment effect of BIMA use on reintervention. However, the IPW approach for the overall population effect unusually showed no difference between BIMA and SIMA on reintervention-free survival (HR=1.08, 95% CI: 0.94-1.24). Conclusions and Relevance: The adjusted HR for reintervention after BIMA versus SIMA use in CABG was remarkably different for the two IPW estimates. This difference is attributed to the population represented by the two IPW approaches- the IPW among the treated estimate represents the effect in the average study population, whereas the IPW in the treated represents the effect in the treated population alone. Determining how the study population is balanced (weighted to look like the overall study population versus treated group) is a large driver of treatment effect, and a key element of propensity score methods. Ultimately, the treatment effect estimate desired should drive the choice of propensity score adjustment method.

Trends of coronary revascularization procedures in Gaza

Background: we investigated the results of diagnostic coronary angiography and trends in rates of myocardial revascularization procedure included Percutaneous Coronary Intervention (PCI) and Coronary Artery Bypass Grafting (CABG) procedures in Gaza between 2015 and 2018. Methods: A descriptive retrospective study based on the analysis of all diagnostic Coronary Angiographies (CAG) based on the Ministry of Health hospitals in Gaza City Report and the Center of Bureau of Statistics, to evaluate the annual rate of PCI and CABG volume have been done since January 2015until January 2019. Results: A total of 4887 diagnostic coronary angiography procedures were performed. The mean age of patients was 58.0±10.2 years. A 3245 of cases were male (66.4%). A total of 5225 revascularization procedures (PCI: 4286,CABG: 939) were performed during the study period. From 2014 to 2018 the PCI volume increased by 94 % (80/100 000 to 155/100 000)(P &lt; 0.0001), CABG volume decreased by 47 % (30/100 000 to 17 /100 000) (P &lt;0.0001), PCI/CABG ratio increased from 2.7 to 9.1(P&lt;0.0001).The indications for diagnostic coronary angiography were stable angina (57% of cases), non-ST-elevation acute coronary syndrome (NSE-ACS) in 24.0%, ST-elevation myocardial infarction (STEMI) in 19.0%, the diagnostic coronary angiography results showed significant lesions in 64.5% of patients. About 19.2% of total cases have three vessel disease, 21% have two vessel disease and 24.4% of them have one vessel disease. The segments most involved were Left Anterior Descending Artery (LAD) which was involved in 47.2% of cases. Discussion: We observed dramatic increases in the total coronary revascularization procedures with a marked decrease in CABG and increase in PCI procedures in Gaza.

Ascending aortas from heart donors and CABG patients are not equivalent as control in aortopathy studies

Objectives. A careful selection of reference samples in studies on the pathogenesis of thoracic ascending aorta (TAA) dilation is crucial for reliability, consistency and reproducibility of experimental results. Several studies include control TAA samples from heart donors. Others include samples harvested during coronary artery bypass graft (CABG) procedures or a mix of samples from heart donors and CABG patients. We verified the equivalence/homogeneity of TAA samples from heart donors and CABG patients in terms of basal gene expression and thus their reliability as reference groups in aortopathy studies. Design. We analysed by RT-PCR and Western blot the differential expression of smoothelin, α-smooth muscle actin (α-SMA) and transforming growth factor-β1 (TGF-β1), selected as major players in smooth muscle cell and myofibroblast phenotype and remodelling. The mean age and comorbidities of subjects were consistent with data routinely seen in clinical practice. Results. Data revealed the loss of smoothelin in samples from CABG patients, together with a significant increase of α-SMA, while TGF-β1 dimer showed a marked increase in CABG patients versus heart donors, accompanied by a decrease of the corresponding mRNA. Differences in gene expression were maintained after adjustment for age. However, TGF-β1 mRNA and CABG patients’ age showed a positive correlation (ρ = 0.89, p < .05), while α-SMA mRNA and age showed a negative correlation (ρ = −0.85, p < .05). Conclusions. We revealed the non-equivalence of samples from heart donors and CABG patients, presumably for the presence of microscopic atherosclerotic lesions in CABG patients, suggesting the necessity of a careful selection of control groups in aortopathy studies.

REEVALUATION OF THE DIAGNOSIS RELATED GROUPS SYSTEM IN GREECE: THE EXAMPLE OF CORONARY ARTERY BYPASS GRAFT PROCEDURE

Background. Aim of the current prospective study is to investigate and revise the basic information related to the coronary artery bypass graft (CABG) procedure, in an attempt to reevaluate the current Greek Diagnosis Related Groups (DRGs) system. Methods. In a Greek academic cardiothoracic surgical department, implementing clinical therapeutic protocols, we prospectively recruited 75 patients planned to undergo elective CABG. All basic demographic, medical and perioperative data were gathered in an extensive database, so asto be compared with data predicted by the DRG’s system. Clinical indicators of performance aiming towards quality control were: perioperative mortality, postoperative myocardial infarct, postoperative stroke, postoperative renal failure, total hospital length of stay, rate of reoperation and rate of readmission. Results. None of the study patients deceased. No cases of perioperative myocardial infarct, stroke or renal failure were observed. Two of the patients developed respiratory failure, and one was reoperated for the control of perioperative bleeding. There were no cases of readmission to the hospital. The total length of stay was longer than the DRG’s prediction (mean 11.5 vs 7 days), owed partially to the preoperative stay (mean 3.18days) in the department, due to reasons of medical vigilance and organisatory problems that led to the postponement of the operation. Conclusions. A review of the CABG related DRG’s in Greece seems appropriate, based on the findings of the current study, suggesting a longer than predicted hospital stay.

CABG Delivers Survival Benefit in Ischemic Cardiomyopathy

Among patients who had coronary artery bypass graft (CABG) procedures in addition to medical therapy for coronary artery disease, heart failure, and severe left ventricular systolic dysfunction, the rate of death from any cause was 16% lower over a decade compared with patients treated with medical therapy alone (Velazquez EJ et al. N Engl J Med. 2016;374:1511-1520). The significant survival benefit was evident only in the long-term follow-up of the previously published Surgical Treatment for Ischemic Heart Failure (STICH) trial (Velazquez EJ et al. N Engl J Med. 2011;364:1607-1616); at approximately 5 years, there was no significant difference in all-cause mortality between those who had surgical revascularization vs those who had only medical therapy.

OUTCOMES IN PATIENTS UNDERGOING CORONARY ARTERY BYPASS GRAFTING BASED ON HOSPITAL VOLUME, 2007-2011

The volume of coronary artery bypass grafting (CABG) procedures has been declining. Studies suggest an increased risk of adverse events in patients undergoing CABG at low volume centers; this has yet to be evaluated in a contemporary national registry. We analyzed all patients who had CABG from

A Single Center Experience with Coronary Endarterectomy and Vein Patch Reconstruction

Background: To evaluate the medium and late term outcomes of coronary artery bypass grafting with pull-through coronary endarterectomy using a saphenous vein patch for bypass distal anastomosis site. Methods: Retrospective review of all coronary artery bypass graft (CABG) procedures performed from January 1, 2000 through June 30, 2013 with and without concomitant coronary endarterectomy (CE), was carried out at the Veterans Affairs Medical Center in Washington DC. Patients who underwent concomitant valve operations were excluded. Primary outcome was overall survival, with analyses performed examining CE as well as the use of cardiopulmonary bypass. Secondary outcomes included 30-day mortality and post-operative MI. Results: 1255 CABG operations were performed, 10 of which included CE. All CE procedures were performed with saphenous vein patch. 7 involved left anterior descending artery (LAD) CE with left internal mammary artery (LIMA) conduits. The remaining 3 were diagonal branch artery (D1) CE with saphenous vein bypass conduits. 1-year survival was 70%. 5-year survival was 43% out of 7 patients. Conclusions: Pull-through CE with saphenous vein patch is a safe alternative technique for patients with diffuse coronary artery disease. Perioperative events and intermediate outcomes are favorable, although long-term survival is less than patients without CE.

Abstract 132: The POWR Survey: Patient and Physician Perspectives on Outcomes Weighting in Revascularization.

Objective: To better understand and compare how patients and physicians weight adverse outcomes of coronary revascularization. Background: One in every twenty American adults is living with coronary heart disease. Given the high prevalence, approximately one million percutaneous coronary interventions (PCI) and half a million coronary artery bypass grafting (CABG) procedures are performed each year. The decision between PCI and CABG is based on studies that have looked at differences in major adverse cardiac events (MACE) in various populations. While the outcomes included in the MACE category are impactful, they are selected by physicians and do not include all possible adverse outcomes of coronary revascularization that affect patients. With so many Americans facing the clinical impact of coronary revascularization we wished to see if patients and physicians align in the weighting of twenty outcomes of coronary revascularization that have been identified. Methods: 1500 physicians (500 internists, 500 cardiologists and 500 cardiac surgeons) and 54 patients were invited to fill out a survey over a 12 month period. Patients were approached upstream of diagnostic catheterization. Physicians were invited through an AMA database licensee. All responders were asked to use a rating scale to weight twenty outcomes of coronary revascularization. Results: 54 patient and 57 physician (20 internists, 19 cardiologists and 18 cardiac surgeons) responses were received. Patients weighted stroke the highest (8.83/10), while physicians weighted death the highest (8.63/10). Patients and physicians differed (p&lt;0.01) on myocardial infarction (physicians 6.59, patients 8.13), atrial fibrillation (physicians 4.28, patients 6.67), acute respiratory distress syndrome (ARDS) (physicians 5.94, patients 7.44), pseudoaneurysm (physicians 4.45, patients 6.23), post-operative chronic pain (physicians 5.20, patients 6.38) and procedural cost (physicians 4.22, patients 3.18). Notably patients weighted ARDS, renal failure, major bleeding, atrial fibrillation, mediastinits, post-operative chronic pain, post-procedural angina, pseudoaneurysm, long term plavix and pneumonia heavier than repeat PCI, another commonly used outcome for MACE. Conclusions: Patients and physicians agree on which outcomes are most (death and stroke)and least impactful (incision scar), but there is a lot of variability in between supporting the reporting of more adverse outcomes and not just those included in MACE.

Selection of Antibiotic Prophylaxis for Coronary Artery Bypass Graft (CABG) Procedures in an Era of Rising MRSA Prevalence: A Survey of Current Clinical Practices in the State of California

Selection of Antibiotic Prophylaxis for Coronary Artery Bypass Graft (CABG) Procedures in an Era of Rising MRSA Prevalence: A Survey of Current Clinical Practices in the State of California

Work Status and Return to the Workforce after Coronary Artery Bypass Grafting and/or Heart Valve Surgery: A One-Year-Follow Up Study.

Background. Several characteristics appear to be important for estimating the likelihood of reentering the workforce after surgery. The aim of the present study was to describe work status in a two-year time period around the time of cardiac surgery and estimate the probability of returning to the workforce. Methods. We included 681 patients undergoing coronary artery bypass grafting and/or heart valve procedures from 2003 to 2007 in the North Denmark Region. We linked hospital data to data in the DREAM database which holds information of everyone receiving social benefits. Results. At the time of surgery 17.3% were allocated disability pension and 2.3% were allocated a permanent part-time benefit. Being unemployed one year before surgery reduced the likelihood of return to the workforce (RR = 0.74 (0.60–0.92)) whereas unemployment at the time of surgery had no impact on return to the workforce (RR = 0.96 (0.78–1.18)). Sickness absence before surgery reduced the likelihood of return to the workforce. Conclusion. This study found the work status before surgery to be associated with the likelihood of return to the workforce within one year after surgery. Before surgery one-fifth of the population either was allocated disability pension or received a permanent part-time benefit.

Outcome of patients with ischemic cardiomyopathy undergoing mitral valve surgery combined with coronary artery bypass graft and additional procedures, a retrospective single-centre analysis of 475 consecutive patients

Outcome of patients with ischemic cardiomyopathy undergoing mitral valve surgery combined with coronary artery bypass graft and additional procedures, a retrospective single-centre analysis of 475 consecutive patients

The Effects of Metabolic Syndrome on- Pulmonary Complications in Patients Undergoing on- Pump Coronary Artery Bypass Grafting (CABG) Procedures

The Effects of Metabolic Syndrome on- Pulmonary Complications in Patients Undergoing on- Pump Coronary Artery Bypass Grafting (CABG) Procedures

LONG-TERM SURVIVAL FOLLOWING AORTIC VALVE REPLACEMENT AMONG HIGH-RISK ELDERLY PATIENTS IN THE UNITED STATES: INSIGHTS FROM THE STS ADULT CARDIAC SURGERY DATABASE, 1991-2007

Background —Surgical aortic valve replacement (AVR) remains the standard of care for the treatment of operable, symptomatic aortic valve disease; however, to date, there are limited national data on the contemporary long-term outcomes following AVR in older individuals. Methods and Results —We examined long-term survival among 145,911 AVR patients ≥65 years of age undergoing AVR at 1,026 centers with participation in the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database from 1991-2007. In-hospital complications and long-term survival were stratified by age, STS perioperative risk of mortality (PROM), and several comorbidities. The median patient age was 76 years, with 16% having chronic lung disease, 6% preoperative renal failure, 38% heart failure, and 12% prior cardiac surgery. The median survival in patients aged 65-69, 70-79, and ≥80 years undergoing isolated AVR was 13, 9, and 6 years, respectively. For AVR plus coronary artery bypass graft (CABG) procedures, median survival was 10, 8, and 6 years, respectively. While only 5% of isolated AVR patients had a high STS PROM (≥10%), their median survival was 2.5 to 2.7 years. Severe lung disease and renal failure were each associated with a 50% or greater reduction in median survival among all age groups when compared with those who did not have these comorbidities, while left ventricular dysfunction and prior cardiac operation were associated with a 25% reduction in median survival. Conclusions —Long-term survival following surgical AVR in the elderly is excellent, although patients with a high STS PROM and those with certain comorbidities carry a particularly poor long-term prognosis.

A Retrospective Study of Combined Cardiac and Carotid Surgery

Introduction: A combined carotid endarterectomy (CEA) and cardiac procedure has higher early risk of stroke than isolated CEA because of the widespread atherosclerosis in patients selected for simultaneous procedures. In this retrospective study, we review the results of combined coronary artery bypass grafting (CABG) and carotid endarterectomy (CEA) procedures. Materials and methods: Between January 2000 and December 2007, 91 patients with a mean age of 69.2+6.6 (24/67 female/male) underwent combined operations (CEA-CABG) on cardiopulmonary bypass (CPB) as elective surgery. The study population was divided, as follows: Group A: 83 patients (91.2%) had both venous and arterial revascularization; Group B: 8 patients (8.8%) had total arterial revascularization. CEA was performed in case of stenosis more than 80% and always before cardiac operation. These techniques were used: standard procedure (54.8%), eversion (39.2%), patch enlargement (6%). Immediately after the vascular procedure, CABGs were performed through median sternotomy. The mean EUROscore was 6.9+2.5%. Results: All neurological complications were in the group who underwent both venous and arterial revascularization (Group A), where a proximal anastomosis was made. All complications and deaths were in group A. Six patients had stroke (6.6%) and 2 had acute myocardial infarction (AMI) (2.2%). There were 8 in-hospital deaths (8.8%) and 1 late death (for stroke after five months). Conclusions: In our center, the incidence of stroke in simultaneous cardiovascular procedures was 5.5 times greater than in isolated cardiac or vascular procedures, which was probably related to the widespread vessels disease. An aortic cross clamp and surgical procedure on the ascending aorta are relevant risk factors for developing neurological events; much attention should be paid to aortic manipulation. In the sub-group who underwent total arterial revascularization with associated CEA procedures, we had no neurological events. A partial cross clamp and proximal anastomosis are relevant risk factors for developing neurological events. Therefore, in combined operations (CEA associated with CABG), it is probably more favourable performing a total arterial revascularization, avoiding partial ascending aortic clamping.