Combined off-pump myocardial revascularization and carotid endarterectomy: early experience

Background. Controversy remains regarding the optimal surgical management of patients with coexisting significant carotid and coronary artery disease. The debate has deepened by the evolution of new approaches for the treatment of both coronary and carotid disease. We report our early experience with combined off-pump coronary artery bypass (OPCAB) and carotid endarterectomy (CEA) for the treatment of patients with coexisting coronary and carotid disease. Methods. Our computer database was examined to obtain patients and their demographics and clinical profiles. Operative reports were reviewed. Telephone interviews were conducted to assess follow-up status. Results. Thirteen patients underwent combined OPCAB and CEA. Average age was 71 years. The CEA was performed with intraluminal shunting and patch reconstruction. On average, 3.6 bypass grafts were performed. There were no gross neurologic complications or myocardial infarctions. Excluding an outlier, mean length of hospital stay was 8.2 days. All patients were well on follow-up (2 weeks to 16 months). Conclusions. A combined OPCAB and CEA strategy appears safe and effective. Further follow-up and experience is warranted before conclusions regarding potential benefits of this approach for staged or conventional OPCAB/CEA procedures can be made.