Predicting early mortality following single-stage coronary artery or valve surgery and carotid endarterectomy

Marco Franchin; Walter Dorigo; Stefano Benussi; Sara Speziali; Raffaele Pulli; Stefano Bonardelli; Mohamad Bashir; Gabriele Piffaretti; Collaborativo of Concomitant Cardiac Surgery and Carotid Surgery

doi:10.1111/jocs.17138

Predicting early mortality following single-stage coronary artery or valve surgery and carotid endarterectomy

J Card Surg. 2022 Dec;37(12):4692-4697. doi: 10.1111/jocs.17138. Epub 2022 Nov 9.

Authors

Marco Franchin¹, Walter Dorigo², Stefano Benussi^{3

4}, Sara Speziali², Raffaele Pulli², Stefano Bonardelli³, Mohamad Bashir⁵, Gabriele Piffaretti⁶; Collaborativo of Concomitant Cardiac Surgery and Carotid Surgery

Collaborators

Collaborativo of Concomitant Cardiac Surgery and Carotid Surgery:
Sandro Ferrarese, Matteo Tozzi, Pierluigi Stefano, Barbara Paro, Camilla Zanotti

Affiliations

¹ Department of CardioThoracic and Vascular Surgery, ASST Settelaghi Universitary Teaching Hospital, Varese, Italy.
² CardioThoracic and Vascular Surgery, Vascular Surgery, Careggi University Teaching Hospital, University of Florence School of Medicine, Florence, Italy.
³ Vascular Surgery, Department of Sperimental and Clinical Sciences, University of Brescia School of Medicine, Spedali Civili Hospital, Varese, Italy.
⁴ Cardiac Surgery, Department of Sperimental and Clinical Sciences, University of Brescia School of Medicine, Spedali Civili Hospital, Varese, Italy.
⁵ Vascular & Endovascular Surgery-Health Education & Improvement Wales, Velindre University NHS Trust, Wales, UK.
⁶ Vascular Surgery, Department of Medicine and Surgery, University of Insubria School of Medicine, Varese, Italy.

PMID: 36349716
DOI: 10.1111/jocs.17138

Abstract

Background: Surgical management of coexisting cardiac disease and extra-cranial carotid artery disease is a controversial area of debate. Thus, in this challenging scenario, risk stratification may play a key role in surgical decision making.

Aim: To report the results of single-stage coronary/valve surgery (CVS) and carotid endarterectomy (CEA), and to identify predictive factors associated with 30-day mortality.

Methods: This was a multicenter, retrospective study of prospectively maintained data from three academic tertiary referral hospitals. For this study, only patients treated with single-stage CVS, meaning coronary artery bypass surgery or valve surgery, and CEA between March 1, 2000 and March 30, 2020, were included. Primary outcome measure of interest was 30-day mortality. Secondary outcomes were neurologic events rate, and a composite endpoint of postoperative stroke/death rate.

Results: During the study period, there were 386 patients who underwent the following procedures: CEA with isolated coronary artery bypass graft in 243 (63%) cases, with isolated valve surgery in 40 (10.4%), and combination of coronary artery bypass grafting and valve surgery in 103 (26.7%). Postoperative neurologic event rate was 2.6% (n = 10) which includes 5 (1.3%) transient ischemic attacks and 5 (1.3%) strokes (major n = 3, minor n = 2). The 30-day mortality rate was 3.9% (n = 15). Predictors of 30-day mortality included preoperative left heart insufficiency (odds ratio [OR]: 5.44, 95% confidence interval [CI]: 1.63-18.17, p = .006), and postoperative stroke (OR: 197.11, 95% CI: 18.28-2124.93, p < .001). No predictor for postoperative stroke and for composite endpoint was identified.

Conclusions: Considering that postoperative stroke rate and mortality was acceptably low, single-stage approach is an effective option in such selected high-risk patients.

Keywords: carotid endarterectomy and coronary artery bypass graft surgery; carotid endarterectomy and valve surgery; postoperative stroke; single stage intervention.

Publication types

Multicenter Study

MeSH terms

Carotid Stenosis* / complications
Coronary Artery Disease* / complications
Endarterectomy, Carotid* / methods
Humans
Postoperative Complications / etiology
Retrospective Studies
Risk Factors
Stroke* / epidemiology
Stroke* / etiology
Treatment Outcome