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The Annals of Thoracic Surgery, Vol 53, 813-816, Copyright © 1992 by The Society of Thoracic Surgeons
SJ Weiss, FP Sutter, TO Shannon and SM Goldman
We present a surgical technique that we believe provides superior cerebral
protection for simultaneous correction of carotid and cardiac pathology
with low operative mortality and stroke rate. Our study population consists
of 23 consecutive patients undergoing cardiac operation between August 1989
and April 1991 who also had associated critical (greater than 85%) carotid
artery stenosis. Using 20 degrees C systemic hypothermia for cerebral
protection, we performed simultaneous correction of both lesions during the
aortic cross-clamp period, using continuous retrograde blood cardioplegia
for myocardial protection. Mean patient age was 69.4 years; 83% were 65
years or older. Eighty- seven percent had angina, 35% had recent myocardial
infarctions (within 30 days), and 52% had congestive heart failure.
Asymptomatic bruit was found in 39%, and 61% had previous strokes,
neurologic symptoms, or both. All had 85% or greater luminal narrowing on
cerebral angiography, with 65% having severe or critical contralateral
disease as well. Sixty- one percent had associated other vascular
pathology, including peripheral vascular occlusive disease, renal artery
stenosis, or abdominal aortic aneurysm. There were no postoperative strokes
or neurologic events. One early vein graft occlusion resulted in
postoperative myocardial infarction and subsequent death (4.3%).
ARTICLES
Combined cardiac operation and carotid endarterectomy during aortic cross-clamping
Lankenau Hospital, Wynnewood, Pennsylvania.
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