Division of Cardiac Surgery, Catholic University, Rome, Italy.
Angiology. 2012 Apr;63(3):171-7. doi: 10.1177/0003319711409921. Epub 2011 Jun 3.
We evaluated the prevalence of asymptomatic carotid artery disease in patients scheduled for valvular cardiac surgery. Preoperative screening of the carotid arteries was performed. Among 1012 patients scheduled for valvular cardiac surgery, 267 (26.4%) had carotid stenosis graded >50%; 37 had carotid stenosis >70% and underwent combined valvular surgery and carotid endarterectomy (CEA); and 230 (86%) had carotid stenosis >50% to ≤ 69% and received valvular cardiac surgery under hypothermic cardiopulmonary bypass. Operative mortality and the rate of perioperative adverse neurological events were comparable among the groups. During 6.8 years of follow-up, patients with carotid stenosis not exceeding 69% at the time of surgery had CEA more frequently (P < .05) and stroke/transient ischemic attack ([TIA] P < .05) versus patients treated with combined surgery. The prevalence of asymptomatic carotid stenosis is not negligible in patients undergoing isolated valvular surgery. Combined valvular and carotid surgery is safe and reduces the incidence of CEA and stroke/TIA during follow-up.
我们评估了拟行心脏瓣膜手术患者无症状颈动脉疾病的患病率。对颈动脉进行了术前筛查。在 1012 例行心脏瓣膜手术的患者中，267 例（26.4%）颈动脉狭窄分级>50%；37 例颈动脉狭窄>70%，行心脏瓣膜手术和颈动脉内膜切除术（CEA）联合治疗；230 例（86%）颈动脉狭窄>50%至≤69%，行低温体外循环下心脏瓣膜手术。各组间手术死亡率和围手术期不良神经事件发生率无差异。在 6.8 年的随访期间，手术时颈动脉狭窄程度不超过 69%的患者更频繁地接受颈动脉内膜切除术（P<0.05），卒中和短暂性脑缺血发作（TIA）（P<0.05），而非联合手术治疗的患者。在接受单纯心脏瓣膜手术的患者中，无症状颈动脉狭窄的患病率不容忽视。心脏瓣膜和颈动脉联合手术是安全的，可以降低随访期间颈动脉内膜切除术和卒中和 TIA 的发生率。
