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Predicting early mortality following single-stage coronary artery or valve surgery and carotid endarterectomy
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  • Marco Franchin,
  • Walter Dorigo,
  • Stefano Benussi,
  • Sara Speziali,
  • Raffaele Pulli,
  • Stefano Bonardelli,
  • Mohamad Bashir,
  • Gabriele Piffaretti
Marco Franchin
Universita degli Studi dell'Insubria Dipartimento di Medicina e Chirurgia

Corresponding Author:[email protected]

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Walter Dorigo
Azienda Ospedaliero Universitaria Careggi
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Stefano Benussi
Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia
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Sara Speziali
Azienda Ospedaliero Universitaria Careggi
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Raffaele Pulli
Azienda Ospedaliero Universitaria Careggi
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Stefano Bonardelli
Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia
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Mohamad Bashir
NHS Wales Health Education and Improvement Wales
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Gabriele Piffaretti
Universita degli Studi dell'Insubria Dipartimento di Medicina e Chirurgia
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Abstract

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%) TIAs 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 (OR: 5.44, 95%CI: 1.63-18.17, p = 0.006), and postoperative stroke (OR: 197.11, 95%CI: 18.28-2124.93, p < 0.001). 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.
06 Oct 2022Submitted to Journal of Cardiac Surgery
06 Oct 2022Submission Checks Completed
06 Oct 2022Assigned to Editor
08 Oct 2022Reviewer(s) Assigned
10 Oct 2022Review(s) Completed, Editorial Evaluation Pending
10 Oct 2022Editorial Decision: Accept