The Safety of Combined Cardiac and Vascular Operations: How Much is too Much?

Abstract

Objective:

The purpose of this study was to identify factors correlating with a poor outcome following combined cardiac and vascular procedures.

Methods:

We reviewed 45 consecutive patients undergoing combined cardiac and vascular operations. These included cardiac/CEA (n = 27), cardiac/AAA (n = 13), cardiac/AAA/one other vascular reconstruction (n = 4), and cardiac/renal artery bypass (n = 1). Group 1 included all patients with no morbidity or mortality (n = 41) and Group II included patients who died or suffered significant morbidity (stroke, renal failure) (n = 4).

Results:

Overall mortality was 4.4% (2/45). These two patients underwent cardiac surgery combined with two additional vascular procedures (cardiac/AAA/other). In patients undergoing cardiac/CEA or cardiac/AAA, there were no deaths and one stroke (contralateral to CEA). Group II had significantly decreased ejection fraction (39% ± 6% vs 52% ± 1%) and an increased number of procedures (2.75 vs 2.04).

Conclusions:

Combined cardiac surgery and vascular reconstruction can be performed safely. However, multiple vascular reconstructions or the presence of decreased ejection fraction increased operative risk.