ORIGINAL ARTICLE  VASCULAR SECTION 

The Journal of Cardiovascular Surgery 2022 August;63(4):445-53

DOI: 10.23736/S0021-9509.21.12104-4

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Outcome analysis of synchronous carotid endarterectomy and cardiac surgery. Comparison of two anesthetic techniques after propensity score-matching

Sergio BEVILACQUA ¹ ✉, Carlo PRATESI ², Michele F. OSTUNI ¹, Andrea PECCHIONI ¹, Elena GIACOMELLI ², Alfredo G. CERILLO ², Pierluigi STEFANO ²

¹ Department of Anesthesiology and Intensive Care, Careggi University Hospital, Florence, Italy; ² Department of Cardiothoracic and Vascular Surgery, Careggi University Hospital, Florence, Italy

BACKGROUND: The aim of this study was to investigate the outcome of patients undergoing synchronous carotid endarterectomy and coronary and/or other cardiac surgery. The impact of anesthesia on the outcome was examined.
METHODS: A retrospective single-center observational study was performed, to investigate the outcome of 127 consecutive adult patients submitted to synchronous surgery from 2011 to 2019. Cooperative patient general anesthesia for carotid endarterectomy followed by standard general anesthesia for cardiac surgery and standard general anesthesia for the whole surgery were compared after a propensity score analysis.
RESULTS: Primary outcomes were 30-day mortality (3.1%), incidence of stroke (3.1%), and myocardial infarction (0.8%). Agitation upon awakening, postoperative cardiac troponin I release, the increase of serum creatinine, the occurrence of acute kidney injury and the need for continuous renal replacement therapy were the secondary outcomes. A binary logistic regression revealed that cardiopulmonary bypass use, standard general anesthesia for the whole surgery and the European risk score II, were the strongest predictors of any severe postoperative complications. After propensity score matching, general anesthesia for the whole surgery was significantly correlated with the occurrence of any severe postoperative complication (P=0.038).
CONCLUSIONS: Synchronous surgery was performed with acceptable mortality and complication rate even in combination with other than isolated coronary surgery. Cooperative patient general anesthesia during carotid endarterectomy, was not inferior to general anesthesia in this setting.

KEY WORDS: Endarterectomy, Carotid arteries; Surgical procedures, operative; Anesthesia, general; Conscious sedation; Propensity score