Background: Surgical treatment of concomitant coronary and carotid artery disease is controversial. Our operative strategy is to perform simultaneous carotid endarterectomy and myocardial revascularization in conjunction with cardiopulmonary bypass with moderate hypothermia. We report our experience this procedure and its short-term results.

Methods: From March 2001 to January 2003, 37 consecutive patients underwent simultaneous carotid endarterectomy and myocardial revascularization in our center. Mean age of the patients was 69.1 ±8.8 years, and 28 patients were 65 years old or older. There were 30 men and seven women. Fourtyfive point nine percent of patients were neurologically symptomatic and 40.5% had bilateral carotid stenosis. The indication for carotid endarterectomy was lumen diameter reduction of more than 70%, thrombogenic endovascular morphology or both. Carotid endarterectomy was performed in conjunction with cardiopulmonary bypass on the beating heart with moderate hypothermia, hemodulition and systemic heparinization for additional cerebral protection.

Results: Two (5.4%) patients died in postoperative early period. One of these patients died due to multiorgan failure following stroke and low cardiac output, other by reason of complications of pulmonary following stroke. There were four perioperative neurologic complications. Two (5.4%) of these patients have developed permanent deficit and died in postoperative early period. Others have recovered completely. There was one (2.7%) perioperative myocardiyal infarction. Thirty-five patients were alive in during study and traced for a mean follow-up of 9.6 months; total follow-up time is 358 patient-months. There were no neurological or cardiac problem.

Conclusions: We believe that simultaneous carotid endarterectomy and myocardial revascularization can be performed with acceptable mortality and morbidity.

Keywords : Cardiopulmonary bypass, carotid endarterectomy, coronary bypass