Antonio Figueredo

Early results after synchronous carotid stent placement and coronary artery bypass graft in patients with asymptomatic carotid stenosis

BACKGROUND The optimal management of patients with combined carotid and coronary artery disease requiring cardiac surgery is still unknown. Staged carotid endarterectomy and carotid artery stenting (CAS), each followed by coronary artery bypass graft (CABG), are options frequently employed. However, for patients with severe carotid artery disease in urgent need of open cardiac revascularization, staged operations may not be the most appropriate alternative. The aim of this study was to describe our experience using a synchronous CAS-CABG method with minimal interprocedural time. We used this synchronous combination of procedures in patients with combined carotid and coronary artery disease admitted for urgent CABG. METHODS Patients with concomitant severe carotid and coronary artery disease scheduled for synchronous CAS and urgent CABG between December 2006 and January 2010 were included in the study. All procedures were performed at a single center: the Cardiovascular Foundation of Colombia, in Floridablanca, Santander, Colombia. The study cohort was characterized according to demographic and clinical characteristics, which included degree of carotid stenosis, presence/absence of preoperative neurological symptoms, and cardiac operative risk profile. All patients underwent CAS under embolic protection devices and then CABG within the next 2 hours. Patients received aspirin pre- and postprocedure but were started on clopidogrel only after CABG. The primary end point of the study was the composite incidence rate of myocardial infarction, stroke, and death 30 days after CAS-CABG. RESULTS Fifteen patients with concomitant severe carotid and coronary artery disease underwent synchronous CAS-CABG. Most patients (60%) were men, and mean (± standard deviation) age was 65.2 (± 8.4) years. Most patients (93%) were neurologically asymptomatic. The median (interquartile range) ejection fraction and logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) for the cohort were 55% (36%-62%) and 9.7% (4.6%-14.8%), respectively. There were no deaths, major strokes, minor strokes, or myocardial infarctions during the procedure or within 30 days of CAS-CABG. One patient experienced neurological symptoms likely as a result of transient ischemic attack ipsilateral to the CAS procedure. None of the patients required cardiac or carotid reinterventions, and there were no cases of postoperative bleeding requiring reoperation. CONCLUSIONS Synchronous CAS-CABG, when CABG is performed within the 2 hours of the CAS procedure, may be a viable alternative to the more generally accepted staged combination, particularly among patients for whom CABG cannot be postponed. We hope that this strategy will be further evaluated in larger prospective studies and adequately powered randomized clinical trials.

Utilidad del EuroSCORE en la predicción de mortalidad intrahospitalaria en una institución de enfermedades cardiovasculares de Colombia

(1) Departamento de Cirugia Cardiovascular, Fundacion Cardiovascular de Colombia. Floridablanca, Santander, Colombia.Correspondencia: Dr. Antonio Figueredo, Calle 155 A No. 23-58. Urbanizacion El Bosque. Floridablanca, Santander, Colombia. Telefono: (57-7) 639 6767, 639 9292. Correo electronico: antoniofigueredo@fcv.orgRecibido: 05/10/2012. Aceptado: 05/03/2013.

Tratamiento endovascular del aneurisma de aorta descendente en el adolescente con síndrome de Marfan: Reporte de un caso

Se expone el caso de un adolescente de 14 anos de edad, con sindrome de Marfan y antecedente de tres cirugias cardiovasculares previas: valvuloplastia aortica y mitral a los cinco anos y valvuloplastia aortica y reconstruccion de la aorta toracica con tubo de pericardio bovino a sus diez anos. En primer tiempo quirurgico se realizo reemplazo valvular aortico por valvula mecanica y valvuloplastia mitral y tricuspidea, y en segundo tiempo quirurgico, durante la misma hospitalizacion, exclusion endovascular de aneurisma de aorta descendente asintomatico sin complicaciones. Antes del egreso se diagnostico una endofuga tipo II que se manejo con observacion clinica. Luego de un ano del procedimiento, los controles clinico y tomografico son satisfactorios.