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Nardi P, Altieri C, Pisano C, Oddi FM, Ranucci A, Fresilli M, Salvati AC, Buioni D, Scognamiglio M, Ajello V, Bassano C, Ascoli Marchetti A, Ippoliti A, Ruvolo G. Early-Staged Carotid Artery Stenting Prior to Coronary Artery Bypass Grafting: Analysis of the Early and Mid-Term Results in Comparison with a Consecutive Cohort of Isolated Coronary Artery Surgery Patients. J Clin Med 2024; 13:480. [PMID: 38256614 PMCID: PMC10816890 DOI: 10.3390/jcm13020480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/09/2024] [Accepted: 01/13/2024] [Indexed: 01/24/2024] Open
Abstract
AIM The aim of the present study was to analyze retrospectively the results of patients who underwent early-staged, i.e., within 24-48 h, carotid artery stenting (e-s CAS) before coronary artery bypass grafting (CABG). METHODS Between December 2014 and December 2022, 1046 consecutive patients underwent CABG; 31 of these patients (3%) were subjected to e-s CAS prior to CABG (e-s CAS + CABG group). Preoperative and intraoperative variables and early and mid-term results of the e-s CAS + CABG group were compared with those of patients who underwent isolated CABG (CABG group). RESULTS As compared with the CABG group, the e-s CAS + CABG group showed a worse clinical risk profile due to higher Euroscore-2 values and incidence of obstructive pulmonary disease and bilateral carotid artery and peripheral artery diseases (p < 0.05, for all comparisons). The combined end point of operative mortality, periprocedural myocardial infarction, and stroke was 3.2% (0%/0%/3.2%) in the e-s CAS + CABG group vs. 5.9% (2.2%/2.8%/0.9%) in the CABG group (p > 0.5, for all measurements). At 5 years, actuarial survival was 74% ± 16% in the e-s CAS + CABG group vs. 93% ± 4.0% in the CABG group, freedom from cardiac death was 100% vs. 98% ± 1.0% (p = 0.6), and freedom from MACCEs was 85% ± 15% vs. 97% ± 2.5% (p > 0.1, for all comparisons). Independent predictors of all-causes death were advanced age at the operation (p < 0.0001), a lower value for left ventricular ejection fraction (p = 0.05), and a high Euroscore-2 (p = 0.04). CONCLUSIONS CABG preceded by e-s CAS appears to be associated with satisfactory early outcomes while limiting the risk of myocardial infarction to a very short time interval between the two procedures. Freedom from late all-causes death, cardiac death, and MACCEs were comparable and equally satisfactory, underscoring the positive protective effects of CAS and CABG on the carotid and coronary territories over time.
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Affiliation(s)
- Paolo Nardi
- Cardiac Surgery Division, Tor Vergata University Hospital, 00133 Rome, Italy; (C.P.); (A.C.S.); (D.B.); (M.S.); (C.B.); (G.R.)
| | - Claudia Altieri
- Unit of Cardiology of the Cardiac Surgery Division, Tor Vergata University Hospital, 00133 Rome, Italy;
| | - Calogera Pisano
- Cardiac Surgery Division, Tor Vergata University Hospital, 00133 Rome, Italy; (C.P.); (A.C.S.); (D.B.); (M.S.); (C.B.); (G.R.)
| | - Fabio Massimo Oddi
- Unit of Vascular Surgery, Tor Vergata University Hospital, 00133 Rome, Italy; (F.M.O.); (A.R.); (M.F.); (A.A.M.); (A.I.)
| | - Alessandro Ranucci
- Unit of Vascular Surgery, Tor Vergata University Hospital, 00133 Rome, Italy; (F.M.O.); (A.R.); (M.F.); (A.A.M.); (A.I.)
| | - Mauro Fresilli
- Unit of Vascular Surgery, Tor Vergata University Hospital, 00133 Rome, Italy; (F.M.O.); (A.R.); (M.F.); (A.A.M.); (A.I.)
| | - Alessandro Cristian Salvati
- Cardiac Surgery Division, Tor Vergata University Hospital, 00133 Rome, Italy; (C.P.); (A.C.S.); (D.B.); (M.S.); (C.B.); (G.R.)
| | - Dario Buioni
- Cardiac Surgery Division, Tor Vergata University Hospital, 00133 Rome, Italy; (C.P.); (A.C.S.); (D.B.); (M.S.); (C.B.); (G.R.)
| | - Mattia Scognamiglio
- Cardiac Surgery Division, Tor Vergata University Hospital, 00133 Rome, Italy; (C.P.); (A.C.S.); (D.B.); (M.S.); (C.B.); (G.R.)
| | - Valentina Ajello
- Unit of Cardio-Thoracic Anesthesia, Tor Vergata University Hospital, 00133 Rome, Italy;
| | - Carlo Bassano
- Cardiac Surgery Division, Tor Vergata University Hospital, 00133 Rome, Italy; (C.P.); (A.C.S.); (D.B.); (M.S.); (C.B.); (G.R.)
| | - Andrea Ascoli Marchetti
- Unit of Vascular Surgery, Tor Vergata University Hospital, 00133 Rome, Italy; (F.M.O.); (A.R.); (M.F.); (A.A.M.); (A.I.)
| | - Arnaldo Ippoliti
- Unit of Vascular Surgery, Tor Vergata University Hospital, 00133 Rome, Italy; (F.M.O.); (A.R.); (M.F.); (A.A.M.); (A.I.)
| | - Giovanni Ruvolo
- Cardiac Surgery Division, Tor Vergata University Hospital, 00133 Rome, Italy; (C.P.); (A.C.S.); (D.B.); (M.S.); (C.B.); (G.R.)
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Gerfer S, Bennour W, Chigri A, Elderia A, Krasivskyi I, Großmann C, Gaisendrees C, Ivanov B, Avgeridou S, Eghbalzadeh K, Rahmanian P, Kuhn-Régnier F, Mader N, Djordjevic I, Sabashnikov A, Wahlers T. Major Adverse Cardiac and Cerebrovascular Events in Patients Undergoing Simultaneous Heart Surgery and Carotid Endarterectomy. J Cardiovasc Dev Dis 2023; 10:330. [PMID: 37623343 PMCID: PMC10455249 DOI: 10.3390/jcdd10080330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/13/2023] [Accepted: 08/01/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Patients with simultaneous relevant internal carotid artery stenosis and coronary artery heart or valve disease represent a high-risk collective with respect to cerebral or cardiovascular severe events when undergoing surgery. There exist several concepts regarding the timing and modality of carotid revascularization, which are controversially discussed in patients with heart disease. More data regarding outcome predictors and measures are needed to gain a better understanding of the best treatment option of the discussed patient collective. METHODS This single-center study retrospectively analyzed n = 111 patients undergoing heart surgery with coronary artery bypass grafting or heart-valve surgery and concomitant carotid surgery due to significant internal carotid artery stenosis. In order to do so, patients were divided into two groups with respect to postoperative major adverse cardiac and cerebrovascular events (MACCE) with thirty-day all-cause mortality, valve related mortality, myocardial infarction, stroke and transitory ischemic attack. RESULTS Preoperative patient's characteristic in the no-MACCE and MACCE group were mainly balanced, other than higher rates of chronic obstructive pulmonary disease, chronic kidney disease, instable angina pectoris and prior transitory ischemic attack in the MACCE cohort. The analysis of intraoperative characteristics revealed a higher number of intra-aortic balloon pump implantation, which is in line for a higher number of postoperative supports. Besides MACCE, patients suffered significantly more often from postoperative bleeding events and re-thoracotomy, cardiopulmonary reanimation, new onset postoperative dialysis and prolonged intensive care unit stay related complications. CONCLUSIONS Within the reported patient population suffering from MACCE after a simultaneous carotid endarterectomy and heart surgery, a preoperative history of transitory ischemic attack and kidney disease might account for worse outcomes, as severe events were not only neurologically driven but also associated with postoperative cardiovascular complications following heart surgical procedures.
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Affiliation(s)
- Stephen Gerfer
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, 50937 Cologne, Germany (A.E.); (S.A.)
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