Predicting early mortality following single‐stage coronary artery or valve surgery and carotid endarterectomy. Issue 12 (9th November 2022) - Franchin, Marco
Abstract: 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%) transient ischemic attacks 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 (odds ratio [OR]: 5.44, 95% confidence interval [CI]: 1.63–18.17, p = .006), and postoperative stroke (OR: 197.11, 95% CI: 18.28–2124.93, p < .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.