OBJECTIVE:To determine the early outcomes of surgery in patients who underwent CABG plus CEA and those in whom carotids left untreated in patients having concomitant coronary artery plus carotid artery disease.METHODOLOGY: In this retrospective comparative analysis, we included 60 patients of severe coronary and carotid artery disease, 30 patients who underwent concomitant CABG plus CEA surgery and others who underwent only CABG and no CEA in spite of having severe carotid artery disease.All CEA patients were asymptomatic.These patients were operated from 1-Dec-2010 to 31-Dec-2015.Incidence of stroke and mortality were the primary study outcomes.RESULTS: Mean age of patients in CABG+CEA group was 55.24+6.89versus 57.53+9.42 years in CABG group.There were 80.0% males in CABG+CEA group and 73.3% in CABG group.66.7% patients in CABG+CEA group were hypertensive and there were 63.3% hypertensive patients in CABG group.In patients of CABG+CEA, total 2 (6.6%) patients died.One patient died on operation day when he was on ventilator.His brain could not be assessed.One patient had stroke on opposite side of CEA.Doppler study showed stenosis of CEA graft, so its graft was revised.This patient expired after one week.In patients of CABG only, stroke occurred in one patient and that patients died on 5 th operative day.CONCLUSION: In present study, cerebral morbidity was little high in CABG+CEA patients but with in-significant statistical difference.There is no benefit of prophylactic CEA in cardiac surgery patients having severe asymptomatic carotid artery disease.
To review the surgical outcome of doubly committed subarterial (DCSA) ventricular septal defect repair.Data of 51 patients of doubly committed sub arterial Ventricular septal defect from January 2012 to June 2017 that were referred to Chaudhary Pervaiz Elahi institute of Cardiology Multan was retrospectively reviewed using electronic database. All patients were operated by first author. In our study, we segregated patients into four main groups depending on presence or absence of aortic structural defect and degree of aortic valve regurgitation. Group-A comprised of nineteen (37%) patients who neither had aortic structural nor functional abnormality while Group-B had six (11.7%) patients, having aortic valve cusp prolapse without aortic regurgitation. Group-C and Group-D consists of seventeen (33.3%) and nine (17.6%) patients respectively depending upon degree of aortic regurgitation. Furthermore, six (11.7%) patients among these 51 had associated defects as well.Group-A patients had no aortic valve regurgitation post operatively and at follow up of 22.6 months (1.8 years) as well. In Group-B, aortic valve was not addressed and aortic regurgitation was also not present post operatively or on follow up of 33.6 months (2.8 years). Similarly, in Group-C aortic valve was not addressed, these patients also did not show progression of disease on regular follow up of 18 months (1.5 year). While, in Group-D, eight patients underwent aortic valve repair and one patient had aortic valve replacement. Aortic regurgitation improved significantly in all patients of this group and remained unchanged on follow up of 22.7 months (1.8 years).Early closure of doubly committed subarterial ventricular septal defect with appropriate management of aortic valve disease can halt the process of disease progression.
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