Concomitant carotid and cardiac disease: Short-term results of combined surgery in 76 patients

Aim. Carotid artery stenosis is often associated with advanced coronary artery disease, and this coexistence adds complexity to the medical decision process. Postoperative stroke remains one of the most devastating complications of coronary artery by-pass grafting (CABG), while cardiac uneventful events represent the major not-neurologic complication after carotid endarterectomy (CEA). The timing of CEA and CABG for concomitant disease is still discussed and controversial. The aim of the study is to evaluate the clinical outcome and the costs assessment in the simultaneous carotid and coronary revascularization. Methods. From February 2003 to March 2006 all the patients candidate to CABG underwent imagine studies to detect the presence of significant carotid artery stenosis (duplex scan, angio-MR, angio-CT) and all the patients candidate to CEA with positive history for ischemic heart disease or angina underwent coronarography. The simultaneous presence of carotid and coronary disease was detected in 76 patients that were treated with a combined surgical operation including CEA immediately before CABG, performed in the same operative session (COMBI group). In the same period 651 patients underwent CEA and 676 CABG separately. Results. Mortality was of one patient (1.3%) in the COMBI group, 2 (0.3%) and 11 (1.6%) in CEA and CABG group respectively. Perioperative acute myocardial infarction occurred in 6 patients (7.9%) of COMBI group, in 15 patients (2.3%) of CEA group and in 37 (5.5%) of CABG group. Stroke rate was 2 (2.7%), 4 (0.6%) and 8 (1.2%) patients in COMBI, CEA and CABG group respectively. Conclusion. From an economic point of view, this combined surgical treatment seems to reduce global hospital and National Health Service costs.