The Outcomes of Concomitant Carotid Endarterectomy and Off-Pump Coronary Artery Bypass Grafting.

Abstract

Objective: Limited data exist on the combined use of carotid endarterectomy (CEA) and off-pump coronary artery bypass grafting (OPCABG).

Method: This retrospective study collected data from 42 patients who underwent simultaneous carotid endarterectomy and off-pump coronary artery bypass grafting between November 2015 and June 2023 at two affiliated institutions. CEA was performed first via eversion endarterectomy, followed by OPCABG using mostly arterial grafts on a beating heart, primarily with a "no-touch" aortic technique. Patient data were obtained from digital hospital records, and follow-up was completed through electronic systems or phone contact.

Results: Among 1,154 OPCABG patients, 42 (3.6%) underwent simultaneous CEA, with a median age of 72 (range: 59-84); 35 patients (83.3%) were male and seven (16.7%) female. All patients were asymptomatic for carotid disease and diagnosed preoperatively via routine Doppler ultrasound. Complete arterial revascularization without aortic manipulation was achieved in 83.3% of cases, with a mean of 3.66 +- 1.22 distal anastomoses. Early mortality occurred in one critically ill patient (2.4%). One patient (2.4%) experienced a postoperative transient ischemic attack and recovered without neurologic sequelae. Seventeen patients (40.4%) were extubated in the operating room. During follow-up, no patients experienced cerebrovascular events; two patients died due to non-cardiac disease. As all events occurred within the first year, the Kaplan-Meier one-, three-, and five-year stroke-free survival rates were identical at 92.6 +- 4.1%.

Conclusion: Concomitant CEA and OPCABG surgery is considered the optimal strategy for patients with extensive carotid and coronary artery stenosis at experienced centers. It is an achievable treatment that minimizes the risk of postoperative cerebrovascular events and cognitive deficits.