Publicação
Synchronous carotid and cardiac surgery : a low risk procedure in high-risk patients
| Resumo: | Background: Neurologic complications remain an important risk of cardiac surgery, as stroke occurs in about 2% of all myocardial revascularization procedures. The causes of post-CABG stroke are multifactorial and it is not fully understood whether the presence of concomitant severe carotid disease increases the risk of the cardiac procedure. Several strategies have been attempted, and the synchronous carotid and cardiac surgery is a procedure that is frequently performed worldwide in patients with multiple comorbidities. Objectives: (1) To analyse the safety of the synchronous surgery, when performed by an experienced team, in high-risk patients; (2) To compare the mortality and the risk of stroke between patients with different degrees of stenosis or undergoing on surgery with extracorporeal circulation and off-pump; (3) To evaluate the Euroscore as a tool to establish the prognosis of patients undergoing cardiac surgery. Methods: A retrospective study was conducted, including two groups of a total of 217 patients, with different degrees of stenosis, undergoing synchronous cardiac and carotid surgery, between the years 2000-2017 in Hospital Santa Maria, Lisbon. The statistical analysis was performed using a Fisher test or a χ2 test and a Mann-whitney test. Results: Overall, only 1 patient (0.46%) has suffered an ipsilateral stroke 24 hours after the procedure. Four patients (1.84%) had suffered an ischemic or haemorrhagic stroke on the contralateral hemisphere or on the cerebellum and the global mortality rate was 7.83%. We have not registered a significant difference in the mortality rates (p=0.524) between patients with different degrees of stenosis. There is no significant difference in the mortality rates (p=0.521) in patients undergoing surgery with extracorporeal circulation and off-pump. There is an increasing risk of death (p=0.0041) and risk of major complications (p=0.0006) in patients with higher Euroscores. Conclusions: The synchronous surgery, performed by an experienced team, has a very low neurological risk, even in patients with high Euroscore levels and significant co-morbidities. The extension of the carotid disease among the groups we have studied did not have different significant outcomes. |
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| Autores principais: | Meireles, Pedro Miguel Antunes |
| Assunto: | Acidente vascular cerebral Estenose carotídea Cirurgia cardíaca Cirurgia síncrona |
| Ano: | 2017 |
| País: | Portugal |
| Tipo de documento: | dissertação de mestrado |
| Tipo de acesso: | acesso aberto |
| Instituição associada: | Universidade de Lisboa |
| Idioma: | inglês |
| Origem: | Repositório da Universidade de Lisboa |
| Resumo: | Background: Neurologic complications remain an important risk of cardiac surgery, as stroke occurs in about 2% of all myocardial revascularization procedures. The causes of post-CABG stroke are multifactorial and it is not fully understood whether the presence of concomitant severe carotid disease increases the risk of the cardiac procedure. Several strategies have been attempted, and the synchronous carotid and cardiac surgery is a procedure that is frequently performed worldwide in patients with multiple comorbidities. Objectives: (1) To analyse the safety of the synchronous surgery, when performed by an experienced team, in high-risk patients; (2) To compare the mortality and the risk of stroke between patients with different degrees of stenosis or undergoing on surgery with extracorporeal circulation and off-pump; (3) To evaluate the Euroscore as a tool to establish the prognosis of patients undergoing cardiac surgery. Methods: A retrospective study was conducted, including two groups of a total of 217 patients, with different degrees of stenosis, undergoing synchronous cardiac and carotid surgery, between the years 2000-2017 in Hospital Santa Maria, Lisbon. The statistical analysis was performed using a Fisher test or a χ2 test and a Mann-whitney test. Results: Overall, only 1 patient (0.46%) has suffered an ipsilateral stroke 24 hours after the procedure. Four patients (1.84%) had suffered an ischemic or haemorrhagic stroke on the contralateral hemisphere or on the cerebellum and the global mortality rate was 7.83%. We have not registered a significant difference in the mortality rates (p=0.524) between patients with different degrees of stenosis. There is no significant difference in the mortality rates (p=0.521) in patients undergoing surgery with extracorporeal circulation and off-pump. There is an increasing risk of death (p=0.0041) and risk of major complications (p=0.0006) in patients with higher Euroscores. Conclusions: The synchronous surgery, performed by an experienced team, has a very low neurological risk, even in patients with high Euroscore levels and significant co-morbidities. The extension of the carotid disease among the groups we have studied did not have different significant outcomes. |
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