Clinical utility of carotid duplex ultrasound prior to cardiac surgery

Autor: Kathleen P. Wertella, Jeffrey A. Morgan, Khalil Masabni, Sara Brooks, Judith C. Lin, Edward L. Peterson, Loay S. Kabbani, Gaetano Paone
Rok vydání: 2016
Předmět:
Male
medicine.medical_specialty
Databases
Factual
medicine.medical_treatment
Carotid endarterectomy
030204 cardiovascular system & hematology
Risk Assessment
Severity of Illness Index
Preoperative care
Tertiary Care Centers
Duplex scanning
03 medical and health sciences
0302 clinical medicine
Predictive Value of Tests
Risk Factors
Preoperative Care
medicine
Humans
Carotid Stenosis
cardiovascular diseases
030212 general & internal medicine
Coronary Artery Bypass
Stroke
Aged
Retrospective Studies
Endarterectomy
Endarterectomy
Carotid
Ultrasonography
Doppler
Duplex
business.industry
Patient Selection
Perioperative
Middle Aged
medicine.disease
Surgery
Cardiac surgery
Cerebrovascular Disorders
Carotid Arteries
Treatment Outcome
Cardiothoracic surgery
Female
Cardiology and Cardiovascular Medicine
business
Zdroj: Journal of Vascular Surgery. 63:710-714
ISSN: 0741-5214
Popis: Clinical utility and cost-effectiveness of carotid duplex examination prior to cardiac surgery have been questioned by the multidisciplinary committee creating the 2012 Appropriate Use Criteria for Peripheral Vascular Laboratory Testing. We report the clinical outcomes and postoperative neurologic symptoms in patients who underwent carotid duplex ultrasound prior to open heart surgery at a tertiary institution.Using the combined databases from our clinical vascular laboratory and the Society of Thoracic Surgery, a retrospective analysis of all patients who underwent carotid duplex ultrasound within 13 months prior to open heart surgery from March 2005 to March 2013 was performed. The outcomes between those who underwent carotid duplex scanning (group A) and those who did not (group B) were compared.Among 3233 patients in the cohort who underwent cardiac surgery, 515 (15.9%) patients underwent a carotid duplex ultrasound preoperatively, and 2718 patients did not (84.1%). Among the patients who underwent carotid screening vs no screening, there was no statistically significant difference in the risk factors of cerebrovascular disease (10.9% vs 12.7%; P = .26), prior stroke (8.2% vs 7.2%; P = .41), and prior transient ischemic attack (2.9% vs 3.3%; P = .24). For those undergoing isolated coronary artery bypass grafting (CABG), 306 (17.8%) of 1723 patients underwent preoperative carotid duplex ultrasound. Among patients who had carotid screening prior to CABG, the incidence of carotid disease was low: 249 (81.4%) had minimal or mild stenosis (50%); 25 (8.2%) had unilateral moderate stenosis (50%-69%); 10 (3.3%) had bilateral moderate stenosis; 9 (2.9%) had unilateral severe stenosis (70%-99%); 5 (1.6%) had contralateral moderate stenosis; 2 (0.7%) had bilateral severe stenosis; 4 (1.3%) had unilateral occluded with contralateral less than 50% stenosis, 1 (0.3%) had unilateral occluded with contralateral (70%-99%) stenosis; and 1 had bilateral occluded carotid arteries. Primary outcomes of patients who underwent isolated CABG showed no difference in the perioperative mortality (2.9% vs 4.3%; P = .27) and stroke (2.9% vs 2.6%; P = .70) between patients undergoing preoperative duplex scanning and those who did not. Primary outcomes of patients who underwent open heart surgery also showed no difference in the perioperative mortality (5.1% vs 6.9%; P = .14) and stroke (2.6% vs 2.4%; P = .85) between patients undergoing preoperative duplex scanning and those who did not. Operative intervention of severe carotid stenosis prior to isolated CABG occurred in 2 of the 17 patients (11.8%) identified who underwent carotid endarterectomy with CABG.In this study, the correlation between preoperative duplex-documented high-grade carotid stenosis and postoperative stroke was low. Prudent use of preoperative carotid duplex ultrasound should be based on the presence of cerebrovascular symptoms and the type of open heart surgery.
Databáze: OpenAIRE
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