The presence of carotid artery disease is known risk factor for perioperative stroke in cardiac surgery. The optimal management of patients with concomitant heart and carotid artery disease is not known. Simultaneous or staged carotid endarterectomy has been proposed to prevent stroke. In an attempt to reduce perioperative morbidity and mortality, simultaneous carotid stenting and cardiac surgery were implemented (hybrid procedure). The aim of this study was to evaluate early and mid-term results after the hybrid procedure.
During a period from November 2012 through November 2018, 54 patients (36 males, an average age 65.8±7.3 years) underwent hybrid procedure. The primary endpoints were the occurrence of perioperative cerebral stroke, transient ischemic attack (TIA), acute myocardial infarction (AMI), bleeding or death. The mean follow-up period was 30 months.
Thirty-day mortality was 0%. Periprocedural incidence of stroke and TIA were 1.9 % and 7.6 %, respectively, while AMI occurred in one patient (1.9 %). No pts required rethoracotomy for bleeding. Four patients died during follow-up (7.6 %), 2 dues to the stroke (3.8%), one due to the heart failure (1.9%), and one due to the multiorgan failure (1.9%). In-stent restenosis of the carotid artery occurred in one case (1.9%).
In this small group of patients, the hybrid procedure was proved to be a safe and efficient way of treatment for patients with concomitant carotid and cardiac diseases. The low rate of perioperative complications and good midterm results are encouraging.

Copyright © 2020. Published by Elsevier Inc.

References

PubMed