Hybrid Carotid And Coronary Revascularization. Safety And Feasibility Study.
Jacek Piątek, Anna Kędziora, Janusz Konstanty-Kalandyk, Marcin Wróżek, Krzysztof Bartuś, Bogusław Kapelak.
John Paul II Hospital, Kraków, Poland.
Background: Concurrent carotid and coronary disease affects an increasing number of patients eligible for surgical coronary revascularization. Assuredly, higher perioperative risk is observed in these individuals. Combined one-day intervention may reduce the postoperative major cardiac and cerebrovascular events (MACCE) rate; however, bleeding and renal complications can be observed more frequently. To asses safety and feasibility of hybrid carotid and coronary revascularization. Methods: Retrospective cohort study including 57 consecutive patients (42 males, 15 females; mean age 70.8±6.9 years) with median EuroSCORE II of 2.4% (1.7-3.0) who underwent hybrid one-day carotid and coronary revascularization. Results: No 30-day mortality or MACCE were observed and patients were usually discharged on postoperative day 8. Postoperative chest-tube output significantly increased after receiving Clopidogrel (0.2 vs 0.4 ml/kg/h; p<0.001). Bleeding events, including re-exploration for bleeding, pleural hematoma, cardiac tamponade, active bleeding (>1.5ml/kg/h), massive blood product transfusions (≥5 units of PRBC or FFP), and gastrointestinal bleeding occurred in 19.3% of individuals. Platelet count ≤110 000 at the cessation of extracorporeal circulation increased the risk of bleeding event (OR 5.7 (1.39-23.36); p=0.016). Acute kidney injury was observed in 22.8% of patients and the risk increased with the duration of extracorporeal circulation (OR 1.41 (1.06-1.88); p=0.02 for every 10 minutes). At the median follow-up of 28 (12.5-61) months MACCE occurred with 21.1% rate and was predicted by EuroSCORE II in a Cox-regression model (HR 1.71 (1.11-2.64); p=0.016). Conclusions: Hybrid carotid and coronary revascularization may be performed with acceptable outcome in a specialized cardiac center.
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