John Parker Gott, MD, Vinod H Thourani, MD, Carolyn E Wright, MS, W

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Presentation transcript:

Risk neutralization in cardiac operations: detection and treatment of associated carotid disease John Parker Gott, MD, Vinod H Thourani, MD, Carolyn E Wright, MS, W.Morris Brown, MD, Andrew B Adams, BS, George M Skardasis, MD, William M McKinnon, MD, Patrick M Battey, MD, Robert A Guyton, MD The Annals of Thoracic Surgery Volume 68, Issue 3, Pages 850-856 (September 1999) DOI: 10.1016/S0003-4975(99)00845-0

Fig 1 Bar graph showing increasing application of duplex screening over time as overall cardiac surgical volume increased. The Annals of Thoracic Surgery 1999 68, 850-856DOI: (10.1016/S0003-4975(99)00845-0)

Fig 2 Representation of carotid duplex scan results for the 1,719 patients, arrayed by age and severity of carotid disease. Tight stenoses are seen in the younger strata, which reinforces that advanced age should not be the sole screening criterion. The Annals of Thoracic Surgery 1999 68, 850-856DOI: (10.1016/S0003-4975(99)00845-0)

Fig 3 Distribution of perioperative strokes by cause. In many previous series carotid artery stroke accounted for up to a third of perioperative strokes. The Annals of Thoracic Surgery 1999 68, 850-856DOI: (10.1016/S0003-4975(99)00845-0)

Fig 4 Distribution by age of patients who had combined carotid and cardiac operations. Despite the age screening criterion (≥ 65 years), inclusion of left main coronary artery disease and previous central nervous system criteria led to detection of significant stenoses in the younger patients. The Annals of Thoracic Surgery 1999 68, 850-856DOI: (10.1016/S0003-4975(99)00845-0)

Fig 5 Algorithm demonstrating elimination of risk of carotid artery stroke with aggressive detection and treatment. Inclusion of carotid endarterectomy (CEA) for patients with carotid stenoses greater than 80% significantly reduced the risk for carotid type stroke (CVA) (p = 0.0001; odds ratio, 20.2). The Annals of Thoracic Surgery 1999 68, 850-856DOI: (10.1016/S0003-4975(99)00845-0)

Fig 6 Actuarial curves demonstrating survival and freedom from new stroke (CVA) after release from hospital. The Annals of Thoracic Surgery 1999 68, 850-856DOI: (10.1016/S0003-4975(99)00845-0)