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Major Adverse Cardiac and Cerebrovascular Events in Patients Undergoing Simultaneous Heart Surgery and Carotid Endarterectomy

Background. Patients with simultaneous relevant internal carotid artery stenosis and coronary artery heart or valve disease represent a high-risk collective with respect to cerebral or cardiovascular severe events when undergoing surgery. There exist several concepts regarding the timing and modalit...

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Autores principales: Gerfer, Stephen, Bennour, Walid, Chigri, Alina, Elderia, Ahmed, Krasivskyi, Ihor, Großmann, Clara, Gaisendrees, Christopher, Ivanov, Borko, Avgeridou, Soi, Eghbalzadeh, Kaveh, Rahmanian, Parwis, Kuhn-Régnier, Ferdinand, Mader, Navid, Djordjevic, Ilija, Sabashnikov, Anton, Wahlers, Thorsten
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10455249/
https://www.ncbi.nlm.nih.gov/pubmed/37623343
http://dx.doi.org/10.3390/jcdd10080330
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author Gerfer, Stephen
Bennour, Walid
Chigri, Alina
Elderia, Ahmed
Krasivskyi, Ihor
Großmann, Clara
Gaisendrees, Christopher
Ivanov, Borko
Avgeridou, Soi
Eghbalzadeh, Kaveh
Rahmanian, Parwis
Kuhn-Régnier, Ferdinand
Mader, Navid
Djordjevic, Ilija
Sabashnikov, Anton
Wahlers, Thorsten
author_facet Gerfer, Stephen
Bennour, Walid
Chigri, Alina
Elderia, Ahmed
Krasivskyi, Ihor
Großmann, Clara
Gaisendrees, Christopher
Ivanov, Borko
Avgeridou, Soi
Eghbalzadeh, Kaveh
Rahmanian, Parwis
Kuhn-Régnier, Ferdinand
Mader, Navid
Djordjevic, Ilija
Sabashnikov, Anton
Wahlers, Thorsten
author_sort Gerfer, Stephen
collection PubMed
description Background. Patients with simultaneous relevant internal carotid artery stenosis and coronary artery heart or valve disease represent a high-risk collective with respect to cerebral or cardiovascular severe events when undergoing surgery. There exist several concepts regarding the timing and modality of carotid revascularization, which are controversially discussed in patients with heart disease. More data regarding outcome predictors and measures are needed to gain a better understanding of the best treatment option of the discussed patient collective. Methods. This single-center study retrospectively analyzed n = 111 patients undergoing heart surgery with coronary artery bypass grafting or heart-valve surgery and concomitant carotid surgery due to significant internal carotid artery stenosis. In order to do so, patients were divided into two groups with respect to postoperative major adverse cardiac and cerebrovascular events (MACCE) with thirty-day all-cause mortality, valve related mortality, myocardial infarction, stroke and transitory ischemic attack. Results. Preoperative patient’s characteristic in the no-MACCE and MACCE group were mainly balanced, other than higher rates of chronic obstructive pulmonary disease, chronic kidney disease, instable angina pectoris and prior transitory ischemic attack in the MACCE cohort. The analysis of intraoperative characteristics revealed a higher number of intra-aortic balloon pump implantation, which is in line for a higher number of postoperative supports. Besides MACCE, patients suffered significantly more often from postoperative bleeding events and re-thoracotomy, cardiopulmonary reanimation, new onset postoperative dialysis and prolonged intensive care unit stay related complications. Conclusions. Within the reported patient population suffering from MACCE after a simultaneous carotid endarterectomy and heart surgery, a preoperative history of transitory ischemic attack and kidney disease might account for worse outcomes, as severe events were not only neurologically driven but also associated with postoperative cardiovascular complications following heart surgical procedures.
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spelling pubmed-104552492023-08-26 Major Adverse Cardiac and Cerebrovascular Events in Patients Undergoing Simultaneous Heart Surgery and Carotid Endarterectomy Gerfer, Stephen Bennour, Walid Chigri, Alina Elderia, Ahmed Krasivskyi, Ihor Großmann, Clara Gaisendrees, Christopher Ivanov, Borko Avgeridou, Soi Eghbalzadeh, Kaveh Rahmanian, Parwis Kuhn-Régnier, Ferdinand Mader, Navid Djordjevic, Ilija Sabashnikov, Anton Wahlers, Thorsten J Cardiovasc Dev Dis Article Background. Patients with simultaneous relevant internal carotid artery stenosis and coronary artery heart or valve disease represent a high-risk collective with respect to cerebral or cardiovascular severe events when undergoing surgery. There exist several concepts regarding the timing and modality of carotid revascularization, which are controversially discussed in patients with heart disease. More data regarding outcome predictors and measures are needed to gain a better understanding of the best treatment option of the discussed patient collective. Methods. This single-center study retrospectively analyzed n = 111 patients undergoing heart surgery with coronary artery bypass grafting or heart-valve surgery and concomitant carotid surgery due to significant internal carotid artery stenosis. In order to do so, patients were divided into two groups with respect to postoperative major adverse cardiac and cerebrovascular events (MACCE) with thirty-day all-cause mortality, valve related mortality, myocardial infarction, stroke and transitory ischemic attack. Results. Preoperative patient’s characteristic in the no-MACCE and MACCE group were mainly balanced, other than higher rates of chronic obstructive pulmonary disease, chronic kidney disease, instable angina pectoris and prior transitory ischemic attack in the MACCE cohort. The analysis of intraoperative characteristics revealed a higher number of intra-aortic balloon pump implantation, which is in line for a higher number of postoperative supports. Besides MACCE, patients suffered significantly more often from postoperative bleeding events and re-thoracotomy, cardiopulmonary reanimation, new onset postoperative dialysis and prolonged intensive care unit stay related complications. Conclusions. Within the reported patient population suffering from MACCE after a simultaneous carotid endarterectomy and heart surgery, a preoperative history of transitory ischemic attack and kidney disease might account for worse outcomes, as severe events were not only neurologically driven but also associated with postoperative cardiovascular complications following heart surgical procedures. MDPI 2023-08-02 /pmc/articles/PMC10455249/ /pubmed/37623343 http://dx.doi.org/10.3390/jcdd10080330 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Gerfer, Stephen
Bennour, Walid
Chigri, Alina
Elderia, Ahmed
Krasivskyi, Ihor
Großmann, Clara
Gaisendrees, Christopher
Ivanov, Borko
Avgeridou, Soi
Eghbalzadeh, Kaveh
Rahmanian, Parwis
Kuhn-Régnier, Ferdinand
Mader, Navid
Djordjevic, Ilija
Sabashnikov, Anton
Wahlers, Thorsten
Major Adverse Cardiac and Cerebrovascular Events in Patients Undergoing Simultaneous Heart Surgery and Carotid Endarterectomy
title Major Adverse Cardiac and Cerebrovascular Events in Patients Undergoing Simultaneous Heart Surgery and Carotid Endarterectomy
title_full Major Adverse Cardiac and Cerebrovascular Events in Patients Undergoing Simultaneous Heart Surgery and Carotid Endarterectomy
title_fullStr Major Adverse Cardiac and Cerebrovascular Events in Patients Undergoing Simultaneous Heart Surgery and Carotid Endarterectomy
title_full_unstemmed Major Adverse Cardiac and Cerebrovascular Events in Patients Undergoing Simultaneous Heart Surgery and Carotid Endarterectomy
title_short Major Adverse Cardiac and Cerebrovascular Events in Patients Undergoing Simultaneous Heart Surgery and Carotid Endarterectomy
title_sort major adverse cardiac and cerebrovascular events in patients undergoing simultaneous heart surgery and carotid endarterectomy
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10455249/
https://www.ncbi.nlm.nih.gov/pubmed/37623343
http://dx.doi.org/10.3390/jcdd10080330
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