Background
There is ongoing debate regarding the optimal strategy and timing for the surgical
management of patients with severe concomitant carotid and coronary artery disease.
Anaortic off-pump coronary artery bypass (anOPCAB), which avoids aortic manipulation
and cardiopulmonary bypass, has been shown to reduce the risk of perioperative stroke.
We present the outcomes of a series of synchronous carotid endarterectomy (CEA) and
anOPCAB.
Methods
A retrospective review was performed. The primary endpoint was stroke at 30 days post-operation.
Secondary endpoints included transient ischaemic attack, myocardial infarction and
mortality 30 days post-operation.
Results
From 2009 to 2016, 1,041 patients underwent anOPCAB with a 30-day stroke rate of 0.4%.
The majority of patients had preoperative carotid-subclavian duplex ultrasound screening
and 39 were identified with significant concomitant carotid disease who underwent
synchronous CEA-anOPCAB. The mean age was 71±7.5 years. Nine patients (23.1%) had
previous neurological events. Thirty (30) patients (76.9%) underwent an urgent operation.
For CEA, a conventional longitudinal carotid endarterectomy with patch angioplasty
was performed in all patients. For anOPCAB, total arterial revascularisation rate
was performed in 84.6% and the mean number of distal anastomoses was 2.9±0.7. In the
30-day postoperative period, there was one stroke (2.63%), two deaths (5.26%), two
transient ischemic attacks (TIAs) (5.26%) and no myocardial infarction. Two patients
experienced acute kidney injury (5.26%), one of which required haemodialysis (2.63%).
Mean length of stay was 11.37±7.9 days.
Conclusion
Synchronous CEA and anOPCAB is a safe and effective option for patients’ severe concomitant
disease. Preoperative carotid-subclavian ultrasound screening allows identification
of these patients.
Keywords
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Article info
Publication history
Published online: March 10, 2023
Accepted:
January 29,
2023
Received in revised form:
December 26,
2022
Received:
October 6,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
