OPEN HEART SURGERY OR CAROTID ENDARTERECTOMY. WHICH PROCEDURE SHOULD BE DONE FIRST?

Abstract

Introduction: Ischemic stroke is a predictable complication of cardiac surgery specially in patients with previous diagnosed carotid stenosis. On the other side, patients undergoing carotid endarterectomy with concomitant significant valvular or coronary artery disease, may face worst peri-operative outcomes. Objective: Analyzing outcomes from a pool of patients with both comorbidities wondering which procedure should be conducted first. Material and Methods: Retrospective analysis of a group of patients submitted to carotid endarterectomy (Group I) between January 2011 and December 2017 that concomitantly presented coronary artery or valvular disease. Outcomes comparison with a group of patients submitted to cardiac surgery (Group II) that concomitantly presented carotid stenosis. Results: There was no statistically significant difference in patient stroke risk-factors between groups. Adverse events rate difference between groups did not reach statistical significance (stroke 1,7% vs 2,8% p=0,698; Acute myocardial infarct 1,7% vs 2,8% p=0,698, death 0% vs 4,6% p=0,073). Discussion: Handling these specific pools of patients is still debatable. Both interventions demand a multidisciplinary approach so as an experienced surgery and anaesthesiology team to individually select which approach fits each patient better.

Keywords

• Carotid endarterectomy
• Open heart surgery
• Carotid stenosis
• Stroke
• Combined surgery
• Coronary event