OUTCOME OF COMBINED CORONARY-ARTERY BYPASS AND CAROTID ENDARTERECTOMY IN SEPTUAGENARIANS AND OCTOGENARIANS

Background: The timing and results of simultaneous single-stage coronary artery bypass graft (CABG) and carotid endarterectomy (CEA) remain controversial. Methods: Simultaneous single-stage CABG and CEA were performed in 22 patients, aged 70 to 82 (mean, 74.9+/-1.0 years). There were 17 men and 5 women. CABG was elective in 11 patients, urgent in nine, and emergent in two patients. Twelve patients (55%) had triple-vessel disease, and 10 (45%) had left main stem lesions. Five patients (23%) had preoperative ejection fraction less than 30%. Asymptomatic carotid stenosis greater than 70% was detected in 36% of patients. Eighteen (82%) had severe bilateral carotid artery stenosis. Sequential reconstruction of the carotid artery followed by CABG was performed in all patients. Results: The average number of grafts was 3.1 +/- 0.2 per patient. Operative mortality was 4.5%. The overall neurologic complication rate was 9.1% (two of 22 patients) with contralateral hemispheric strokes to the carotid arteries on which we operated. Other major complications included ventricular tachycardia (13.6%), myocardial infarction (4.5%), respiratory failure (9.1%), and renal failure (4.5%). Postoperative complications correlated with longer hospital stays (mean, 21.5 days). There was one late death during a mean follow-up of 25.2 months. The actuarial probability of survival was 94.6%, and probability of freedom from cardiovascular disease symptoms was 84%. Conclusions: Although combined CEA and CABG in patients over 70 years of age may result in increased perioperative morbidity, the long-term survival and freedom from cardiovascular and neurologic sequelae are excellent.