Off pump concomitant coronary revascularization and carotid endarterectomy

Aim. Off pump coronary revascularization has emerged as a viable option in the treatment of coexisting clinically significant carotid and coronary artery disease. To this end, we report our recent experience with combined carotid endarterectomy (CEA) and off pump coronary artery bypass (OPCAB). Methods. Our prospectively updated database was queried to identify all patients who underwent combined OPCAB/CEA between January 1, 1999 and December 31, 2002. A total of 38 patients were identified. They were subsequently compared to a contemporaneous cohort of isolated off-pump patients divided into those with and without cerebrovascular disease (CVD). Results. Mean age of the study population was 71±7.0 years, 23 patients (58%) had significant left main disease, 5 (13%) suffered a previous stroke and 5 (13%) had ejection fractions ≤30%. The study group had 1 postoperative myocardial infarction and no postoperative cerebrovascular accidents (CVA). There was 1 in-hospital death (3%) however, there were no significant differences noted in mortality between the study groups. Conclusion. The optimal management of the multifocal atherosclerotic patient remains controversial and this dilemma is further clouded by the recent introduction of OPCAB, and more recently, carotid stenting. Our results suggest that combined OPCAB/CEA is safe and may reduce the risk of postoperative stroke. An economic benefit may also be inferred from shorter hospitalization as well as eliminating the need for another procedure. Randomization and long term follow-up are now required to verify these encouraging early findings.