III. MANAGEMENT OF THE “POLYVASCULAR PATIENT”
1. CONCOMITANT CAROTID AND CORONARY ARTERY DISEASE
B. Myocardial revascularization and concomitant carotid artery disease  THE MULTIFOCAL ATHEROSCLEROTIC PATIENT
DIAGNOSIS AND MANAGEMENT IN 2003 

The Journal of Cardiovascular Surgery 2003 June;44(3):407-15

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

Off pump concomitant coronary revascularization and carotid endarterectomy

Beauford R. B., Saunders C. R., Goldstein D. J.

Department of Cardiothoracic Surgery Newark Beth Israel Medical Center and Saint Barnabas Hospital, Newark, NJ, USA

Aim. Off ­pump cor­o­nary revas­cu­lar­iza­tion ­has ­emerged as a ­viable ­option in ­the treat­ment of coex­ist­ing clin­i­cal­ly sig­nif­i­cant carot­id ­and cor­o­nary ­artery dis­ease. To ­this ­end, we ­report ­our ­recent expe­ri­ence ­with com­bined carot­id endar­te­rec­to­my (CEA) ­and ­off ­pump cor­o­nary ­artery ­bypass (­OPCAB).
Methods. Our pros­pec­tive­ly updat­ed data­base ­was quer­ied to iden­ti­fy ­all ­patients ­who under­went com­bined ­OPCAB/­CEA ­between January 1, 1999 ­and December 31, 2002. A ­total of 38 ­patients ­were iden­ti­fied. They ­were sub­se­quent­ly com­pared to a con­tem­po­ra­ne­ous ­cohort of iso­lat­ed ­off-­pump ­patients divid­ed ­into ­those ­with ­and with­out cereb­ro­vas­cu­lar dis­ease (CVD).
Results. Mean ­age of ­the ­study pop­u­la­tion ­was 71±7.0 ­years, 23 ­patients (58%) ­had sig­nif­i­cant ­left ­main dis­ease, ­5 (13%) suf­fered a pre­vi­ous ­stroke ­and 5 (13%) ­had ejec­tion frac­tions ≤30%. The ­study ­group ­had ­1 post­op­er­a­tive myo­car­dial infarc­tion ­and no post­op­er­a­tive cereb­ro­vas­cu­lar acci­dents (CVA). There ­was ­1 in-hos­pi­tal ­death (3%) how­ev­er, ­there ­were no sig­nif­i­cant dif­fer­enc­es not­ed in mor­tal­ity ­between ­the ­study ­groups.
Conclusion. The opti­mal man­age­ment of ­the mul­ti­fo­cal ath­e­ros­cle­rot­ic ­patient ­remains con­tro­ver­sial ­and ­this dilem­ma is fur­ther cloud­ed by ­the ­recent intro­duc­tion of ­OPCAB, ­and ­more recent­ly, carot­id stent­ing. Our ­results sug­gest ­that com­bined ­OPCAB/­CEA is ­safe ­and ­may ­reduce ­the ­risk of post­op­er­a­tive ­stroke. An eco­nom­ic ben­e­fit ­may ­also be ­inferred ­from short­er hos­pi­tal­iza­tion as ­well as elim­i­nat­ing ­the ­need ­for ­another pro­ce­dure. Randomization ­and ­long ­term fol­low-up ­are ­now ­required to ver­i­fy ­these encour­ag­ing ear­ly find­ings.