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Predicting early mortality following single-stage coronary artery or valve surgery and carotid endarterectomy.
Franchin, Marco; Dorigo, Walter; Benussi, Stefano; Speziali, Sara; Pulli, Raffaele; Bonardelli, Stefano; Bashir, Mohamad; Piffaretti, Gabriele.
Afiliação
  • Franchin M; Department of CardioThoracic and Vascular Surgery, ASST Settelaghi Universitary Teaching Hospital, Varese, Italy.
  • Dorigo W; CardioThoracic and Vascular Surgery, Vascular Surgery, Careggi University Teaching Hospital, University of Florence School of Medicine, Florence, Italy.
  • Benussi S; Vascular Surgery, Department of Sperimental and Clinical Sciences, University of Brescia School of Medicine, Spedali Civili Hospital, Varese, Italy.
  • Speziali S; Cardiac Surgery, Department of Sperimental and Clinical Sciences, University of Brescia School of Medicine, Spedali Civili Hospital, Varese, Italy.
  • Pulli R; CardioThoracic and Vascular Surgery, Vascular Surgery, Careggi University Teaching Hospital, University of Florence School of Medicine, Florence, Italy.
  • Bonardelli S; CardioThoracic and Vascular Surgery, Vascular Surgery, Careggi University Teaching Hospital, University of Florence School of Medicine, Florence, Italy.
  • Bashir M; Vascular Surgery, Department of Sperimental and Clinical Sciences, University of Brescia School of Medicine, Spedali Civili Hospital, Varese, Italy.
  • Piffaretti G; Vascular & Endovascular Surgery-Health Education & Improvement Wales, Velindre University NHS Trust, Wales, UK.
J Card Surg ; 37(12): 4692-4697, 2022 Dec.
Article em En | MEDLINE | ID: mdl-36349716
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.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Doença da Artéria Coronariana / Endarterectomia das Carótidas / Estenose das Carótidas / Acidente Vascular Cerebral Tipo de estudo: Clinical_trials / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Humans Idioma: En Ano de publicação: 2022 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Doença da Artéria Coronariana / Endarterectomia das Carótidas / Estenose das Carótidas / Acidente Vascular Cerebral Tipo de estudo: Clinical_trials / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Humans Idioma: En Ano de publicação: 2022 Tipo de documento: Article