J Thorac Cardiovasc Surg 1997;113:424-425
© 1997 Mosby, Inc.
Cost reduction by combined carotid endarterectomy and coronary bypass
Pat O. Daily, MD
8010 Frost St.
San Diego, CA 92123
Reply to the Editor:
I appreciate Dr. Aru's comments. In his series of 24 patients undergoing first-time carotid endarterectomy and coronary artery bypass grafting, the carotid endarterotomy was performed during aortic crossclamping at a body temperature of 28° C and after all distal grafts had been performed. There were no strokes or myocardial infarctions. Certainly, this degree of hypothermia may be an effective way to provide a significant element of cerebral protection during the period of internal carotid artery occlusion for performance of the carotid endarterectomy. It does, of course, extend the period of aortic crossclamping. However, inasmuch as the total number of combined cases was 24, I believe the number of cases should be extended significantly before conclusions can be drawn that are statistically meaningful. Nonetheless, this approach merits further consideration and trial. Furthermore, I believe combined carotid endarterectomy and coronary artery bypass grafting should be performed on a wider basis to determine potential risks and benefits in various subsets of patients to facilitate improved patient selection.
12/8/78171
