Corresponding author:
Gabriele Piffaretti, MD PhD
Vascular Surgery – Department of Medicine and Surgery, University of
Insubria School of Medicine (Varese – Italy)
Via F Guicciardini 9
21100 Varese – Italy
Tel: +39-0332-393259
e-mail: gabriele.piffaretti@uninsubria.it Funding: This paper is
unfunded.
Conflict of interest statement: All these Authors declare no
conflict of interests relevant for this study.
Manuscript word count: 3885
Accepted for the Society for Vascular Surgery 2018 Vascular Annual
Meeting, Boston June 20-23, 2018
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%) TIAs 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 (OR: 5.44, 95%CI: 1.63-18.17, p = 0.006), and
postoperative stroke (OR: 197.11, 95%CI: 18.28-2124.93, p< 0.001). 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.
Word count: 266
Key words: single stage intervention; carotid endarterectomy
and coronary artery bypass graft surgery; carotid endarterectomy and
valve surgery; postoperative stroke