open access

Vol 22, No 1 (2015)
Original articles
Published online: 2015-02-24
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Hybrid strategy for unstable patients with severe carotid and cardiac disease requiring surgery

Oscar A. Mendiz, Carlos M. Fava, Gustavo A. Lev, León R. Valdivieso, Gaspar Caponi, Gustavo F. Hidalgo Alava, Roberto R. Favaloro
DOI: 10.5603/CJ.a2014.0001
·
Pubmed: 24526504
·
Cardiol J 2015;22(1):25-30.

open access

Vol 22, No 1 (2015)
Original articles
Published online: 2015-02-24

Abstract

Background: Concurrent severe carotid and cardiac disease is a challenging situation where staged surgery is probably the most common strategy. However, in patients with an unstable clinical presentation, the best approach is still a matter of debate. The aim of the study was to report in-hospital and midterm outcome in patients who received carotid artery stenting and synchronous cardiac surgery.

Methods: From June 1998 to July 2012, 54 consecutive patients who were treated at a high-volume university medical center with this hybrid approach were included in the study. All of the patients received carotid angioplasty while being administered aspirin and regular unfractionated heparin. Then, all of the patients were immediately transferred to the operating room for coronary and/or cardiac valve surgery. All of the patients were administered aspirin and clopidogrel once bleeding was ruled out, after surgery.

Results: There were 5 in-hospital surgical related deaths, and no patient suffered a stroke or required carotid urgent re-intervention. At follow-up (55 ± 28 months; range 1–144 months), there were no new neurological deficits, while one additional death occurred.

Conclusions: In this series, synchronous carotid stenting and cardiac surgery were feasible with an acceptable complication rate in a high-surgical-risk population, which could not undergo staged procedures.

Abstract

Background: Concurrent severe carotid and cardiac disease is a challenging situation where staged surgery is probably the most common strategy. However, in patients with an unstable clinical presentation, the best approach is still a matter of debate. The aim of the study was to report in-hospital and midterm outcome in patients who received carotid artery stenting and synchronous cardiac surgery.

Methods: From June 1998 to July 2012, 54 consecutive patients who were treated at a high-volume university medical center with this hybrid approach were included in the study. All of the patients received carotid angioplasty while being administered aspirin and regular unfractionated heparin. Then, all of the patients were immediately transferred to the operating room for coronary and/or cardiac valve surgery. All of the patients were administered aspirin and clopidogrel once bleeding was ruled out, after surgery.

Results: There were 5 in-hospital surgical related deaths, and no patient suffered a stroke or required carotid urgent re-intervention. At follow-up (55 ± 28 months; range 1–144 months), there were no new neurological deficits, while one additional death occurred.

Conclusions: In this series, synchronous carotid stenting and cardiac surgery were feasible with an acceptable complication rate in a high-surgical-risk population, which could not undergo staged procedures.

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Keywords

carotid arterial disease, carotid angioplasty, cardiac surgery

About this article
Title

Hybrid strategy for unstable patients with severe carotid and cardiac disease requiring surgery

Journal

Cardiology Journal

Issue

Vol 22, No 1 (2015)

Pages

25-30

Published online

2015-02-24

DOI

10.5603/CJ.a2014.0001

Pubmed

24526504

Bibliographic record

Cardiol J 2015;22(1):25-30.

Keywords

carotid arterial disease
carotid angioplasty
cardiac surgery

Authors

Oscar A. Mendiz
Carlos M. Fava
Gustavo A. Lev
León R. Valdivieso
Gaspar Caponi
Gustavo F. Hidalgo Alava
Roberto R. Favaloro

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