Atheromatous disease of the aorta and perioperative stroke

Andersen, Nicholas D.; Hart, Stephen A.; Devendra, Ganesh; Kim, Esther S.H.; Johnston, Douglas R.; Schroder, Jacob N.; Krasuski, Richard A.

doi:10.1016/j.jtcvs.2017.08.132

Cited by 19 publications

(19 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The reported risk of perioperative stroke is 1.2% for CABG, 1.5% for aortic valve replacement, 2.1% for mitral valve replacement, and 6.6% for proximal aorta replacement surgery [ 28 29 30 ]. The higher risk of cerebral embolism could probably be attributed to surgical techniques including the manipulation of the aorta, cannulation, or cross-clamping or side clamping of the aorta [ 31 ]. In addition, many studies demonstrated a link between aortic atherosclerosis and cerebral embolism across cardiac surgeries [ 29 32 33 ].…”

Section: Risk Factorsmentioning

confidence: 99%

“…Taken together, this suggests that intraoperative cerebral embolism may originate from the atherosclerotic aorta due to the manipulation of the aorta, such as during CPB insertion. Therefore, when CPB insertion or aortic manipulation is anticipated, several techniques are used to screen the aortic atheroma, including manual palpation, transesophageal ultrasound, or epiaortic ultrasound, which has greater sensitivity [ 31 ]. If a severe aortic atheroma is present, alternate bypass cannulation sites should be chosen.…”

Section: Risk Factorsmentioning

confidence: 99%

“…However, randomized trials comparing the outcome between off-pump and on-pump CABG showed that the risk of immediate perioperative stroke or stroke up to five years were not different [ 34 35 36 37 ]. Commercial devices such as Embol-X intra-aortic filtration system or CardioGard embolic protection cannula also provides more direct protection from cerebral embolization [ 31 38 ].…”

Section: Risk Factorsmentioning

confidence: 99%

See 2 more Smart Citations

Perioperative stroke: pathophysiology and management

2018

Korean J Anesthesiol

View full text Add to dashboard Cite

Although perioperative stroke is uncommon during low-risk non-vascular surgery, if it occurs, it can negatively impact recovery from the surgery and functional outcome. Based on the Society for Neuroscience in Anesthesiology and Critical Care Consensus Statement, perioperative stroke includes intraoperative stroke, as well as postoperative stroke developing within 30 days after surgery. Factors related to perioperative stroke include age, sex, a history of stroke or transient ischemic attack, cardiac surgery (aortic surgery, mitral valve surgery, or coronary artery bypass graft surgery), and neurosurgery (external carotid-internal carotid bypass surgery, carotid endarterectomy, or aneurysm clipping). Concomitant carotid and cardiac surgery may further increase the risk of perioperative stroke. Preventive strategies should be individualized based on patient factors, including cerebrovascular reserve capacity and the time interval since the previous stroke.

show abstract

Section: Risk Factorsmentioning

confidence: 99%

Section: Risk Factorsmentioning

confidence: 99%

Section: Risk Factorsmentioning

confidence: 99%

See 1 more Smart Citation

Perioperative stroke: pathophysiology and management

2018

Korean J Anesthesiol

View full text Add to dashboard Cite

show abstract

“…Considering postoperative stroke risk, aortic cannulation may account for embolization in patients with extensive calcifications, but aortic cross-clamping is considered the most dangerous aspect. 4,39 The reduced postoperative stroke risk for OPBHC technique compared with conventional on-pump CABG (Table 6) might represent the direct clinical consequence of the avoidance of aortic cross-clamping. On the other hand, off-pump CABG is often performed in patients with markedly calcified ascending aorta or in patients with history of cerebrovascular events as it is associated with improved neurological outcomes compared with onpump CABG.…”

Section: Discussionmentioning

confidence: 99%

On‐pump beating‐heart coronary artery bypass grafting in high‐risk patients: A systematic review and meta‐analysis

et al. 2020

View full text Add to dashboard Cite

Background Operative technique for surgical myocardial revascularization in high‐risk patients remains an argument of debate. On‐pump coronary artery bypass graft (CABG) with cardioplegic arrest and off‐pump CABG have intrinsic limitations. The hybrid approach of on‐pump beating‐heart CABG (OPBHC) has been proposed over the years with conflicting results. This systematic review and meta‐analysis intends to summarize the contemporary literature. Methods A literature search was conducted through major electronic databases. The systematic review provided a total of 279 articles, of those 17 studies were included in the present study. Results Compared with on‐pump CABG, OPBHC patients showed a preoperative higher risk profile but had reduced early mortality (risk ratio [RR], 0.59, 95% CI, 0.36‐0.97) and reduced postoperative stroke (RR, 0.60, 95% CI, 0.39‐0.91). Also, interesting trends towards reduced postoperative intra‐aortic balloon pump use (RR, 0.56, 95% CI, 0.31‐1.01) and myocardial infarction (RR, 0.48, 95% CI, 0.22‐1.07) were observed. Baseline characteristics and postoperative complications were similar between OPBHC and off‐pump CABG, but limited data are available. The risk of incomplete revascularization in OPBHC is lower than off‐pump CABG (RR, 0.53, 95% CI, 0.33‐0.87) but higher than conventional on‐pump CABG (RR, 1.71, 95% CI, 1.23‐2.39). Conclusion OPBHC is an effective technique to perform surgical revascularization in high‐risk patients as preventing haemodynamic deterioration and guaranteeing adequate end‐organ perfusion. OPBHC represents an alternative technique to on‐pump and off‐pump CABG, in those cases in which complications deriving from cardioplegic arrest or manipulation of the heart are more likely. For these reasons, OPBHC might be useful in patients with recent myocardial infarction or with left ventricular dysfunction.

show abstract

“…However, pursuing this approach would have perhaps put the patient at increased risk for neurologic/ thromboembolic events in the presence of the atheromatous aorta. 7 We, therefore, decided not to pursue this option.…”

Section: Discussionmentioning

confidence: 99%

Proximal Anastomotic Device Malfunction: Salvage Using Alternative Option

Dulam

McCarthy

Guvakov

et al. 2020

Innovations�(Phila)

View full text Add to dashboard Cite

Embolic stroke is a major complication of cardiac surgery and there have been multiple methods developed to reduce this risk. Recent technology has produced 2 primary devices for producing a bloodless and clampless field to perform aortocoronary graft anastomosis. We present a case with a Class V aorta, deployment failure of one device after aortic punch, and salvage of the aortotomy with the other device.

show abstract

Atheromatous disease of the aorta and perioperative stroke

Cited by 19 publications

References 40 publications

Perioperative stroke: pathophysiology and management

Perioperative stroke: pathophysiology and management

On‐pump beating‐heart coronary artery bypass grafting in high‐risk patients: A systematic review and meta‐analysis

Proximal Anastomotic Device Malfunction: Salvage Using Alternative Option

Contact Info

Product

Resources

About