A Difficult Case With Combined Carotid, Aortic Valve and Coronary Artery Disease: A Rational Approach And Patient Management
Abstract
We present our patient who underwent combined carotid and cardiac surgery. A 65-year-old male patient admitted for aortic valve replacement with the diagnosis of aortic stenosis; coronary artery disease with left main coronary artery and bilateral symptomatic carotid artery disease were detected. Right carotid endarterectomy was performed with cervical nerve blockage while awake. After 48 hours of ICU follow-up, aortic valve replacement and coronary artery bypass grafting were performed under cardiopulmonary bypass and aortic cross clamping. No neurological damage was detected during the peroperative follow-up and the 3-month follow-up visits. His cardiac hemodynamics was stable. In such cases, there are centers that prefer to perform cardiac surgery first, carotid surgery first, or both in the same session. However, we argue that the best choice is to make a decision by evaluating the patient's current clinic, cardiac hemodynamics and stroke risk, as in this case.
References
- 1. Weiss SJ, Sutter FP, Shannon TO, Goldman SM. Combined cardiac operation and carotid endarterectomy during aortic cross-clamping. Ann Thorac Surg. 1992 May;53(5):813-6.
- 2. Minami K, Fukahara K, Boethig D, Bairaktaris A, Fritzsche D, Koerfer R. Long-term results of simultaneous carotid endarterectomy and myocardial revascularization with cardiopulmonary bypass used for both procedures. J Thorac Cardiovasc Surg. 2000 Apr;119(4 Pt 1):764-73.
- 3. Udesh R, Solanki P, Mehta A, Gleason T, Wechsler L, Thirumala PD. Carotid artery stenosis as an independent risk factor for perioperative strokes following mitral valve surgical intervention. J Neurol Sci. 2017 Nov 15;382:170-184.
- 4. Mackey WC, Khabbaz K, Bojar R, O'Donnell TF Jr. Simultaneous carotid endarterectomy and coronary bypass: perioperative risk and long-term survival. J Vasc Surg. 1996 Jul;24(1):58-64.
- 5. Ulusal tedavi klavuzu 2021. Ulusal vasküler ve endovasküler cerrahi derneği. Accessed date: 11 May 2021. Available at : https://uvcd.org.tr/wp-content/uploads/2021/04/Ulusal-Tedavi-Klavuzu-2021.pdf
- 6. Naylor R, Cuffe RL, Rothwell PM, Loftus IM, Bell PR. A systematic review of outcome following synchronous carotid endarterectomy and coronary artery bypass: influence of surgical and patient variables. Eur J Vasc Endovasc Surg 2003;26:230-41.
- 7. Snider F, Rossi M, Manni R, Modugno P, Glieca F, Scapigliati A, Luciani N, Vincenzoni C, Schiavello R. Combined Surgery for cardiac and carotid disease: management and results of a rational approach. Eur J Vasc Endovasc Surg. 2000 Dec;20(6):523-7.
- 8. Matsagas MI, Toumpoulis IK, Drossos GE, et al. Bilateral one-stage carotid endarterectomy combined with aortic valve replacement. A case report. Chirurgia 2006;19(4):267-8.
- 9. Nabagiez JP, Bowman KC, Shariff MA, et al. Twenty-four hour staged carotid endarterectomy followed by off-pump coronary bypass grafting for patients with concomitant carotid and coronary disease. Ann Thorac Surg. 2014;98(5):1613-8.
Kombine Karotis, Aort Kapak Ve Koroner Arter Hastalığı Mevcut Zor Bir Olgu: Akılcı Bir Yaklaşım Ve Hasta Yönetimi
Abstract
Halen tartışmalı olan ve farklı yaklaşımlar tercih edilen, kombine karotis ve kardiyak cerrahi yapılan hastamızı literatür eşliğinde sunuyoruz. Aort darlığı tanısı ile aort kapak replasmanı amacıyla yatırılan 65 yaşında erkek hasta; preop tetkiklerinde sol ana koroner arter lezyonlu koroner arter hastalığı ve bilateral semptomatik karotis arter hastalığı tespit edildi. Hastaya öncelikle servikal sinir blokajıyla uyanık olarak sağ karotis endarterektomi yapıldı. 48 saat yoğun bakım takibi sonrasında kardiyopulmoner bypass ve aortik kross klemp altında 21 numara metalik aort kapak replasmanı ve koroner arter bypass greftleme yapıldı. Peroperatif takipleri ve sonrasında 3 aylık kontrollerinde herhangi bir nörolojik hasar tespit edilmedi kardiyak açıdan stabil seyretti. Bu gibi durumlarda önce kardiyak cerrahiyi, önce karotis cerrahisini ya da her ikisini aynı seansta yapmayı tercih eden merkezler mevcuttur. Fakat en doğru tercihin bu vakada olduğu gibi hastanın mevcut kliniği, kardiyak hemodinamisi ve inme riskini değerlendirerek karar vermek olduğunu savunuyoruz.
References
- 1. Weiss SJ, Sutter FP, Shannon TO, Goldman SM. Combined cardiac operation and carotid endarterectomy during aortic cross-clamping. Ann Thorac Surg. 1992 May;53(5):813-6.
- 2. Minami K, Fukahara K, Boethig D, Bairaktaris A, Fritzsche D, Koerfer R. Long-term results of simultaneous carotid endarterectomy and myocardial revascularization with cardiopulmonary bypass used for both procedures. J Thorac Cardiovasc Surg. 2000 Apr;119(4 Pt 1):764-73.
- 3. Udesh R, Solanki P, Mehta A, Gleason T, Wechsler L, Thirumala PD. Carotid artery stenosis as an independent risk factor for perioperative strokes following mitral valve surgical intervention. J Neurol Sci. 2017 Nov 15;382:170-184.
- 4. Mackey WC, Khabbaz K, Bojar R, O'Donnell TF Jr. Simultaneous carotid endarterectomy and coronary bypass: perioperative risk and long-term survival. J Vasc Surg. 1996 Jul;24(1):58-64.
- 5. Ulusal tedavi klavuzu 2021. Ulusal vasküler ve endovasküler cerrahi derneği. Accessed date: 11 May 2021. Available at : https://uvcd.org.tr/wp-content/uploads/2021/04/Ulusal-Tedavi-Klavuzu-2021.pdf
- 6. Naylor R, Cuffe RL, Rothwell PM, Loftus IM, Bell PR. A systematic review of outcome following synchronous carotid endarterectomy and coronary artery bypass: influence of surgical and patient variables. Eur J Vasc Endovasc Surg 2003;26:230-41.
- 7. Snider F, Rossi M, Manni R, Modugno P, Glieca F, Scapigliati A, Luciani N, Vincenzoni C, Schiavello R. Combined Surgery for cardiac and carotid disease: management and results of a rational approach. Eur J Vasc Endovasc Surg. 2000 Dec;20(6):523-7.
- 8. Matsagas MI, Toumpoulis IK, Drossos GE, et al. Bilateral one-stage carotid endarterectomy combined with aortic valve replacement. A case report. Chirurgia 2006;19(4):267-8.
- 9. Nabagiez JP, Bowman KC, Shariff MA, et al. Twenty-four hour staged carotid endarterectomy followed by off-pump coronary bypass grafting for patients with concomitant carotid and coronary disease. Ann Thorac Surg. 2014;98(5):1613-8.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Case Report |
| Authors | |
| Publication Date | November 17, 2021 |
| Published in Issue | Year 2021 Volume: 2 Issue: 3 |
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