The impact of epiaortic ultrasonographic scanning on the risk of perioperative stroke

Zingone, Bartolo; Rauber, Elisabetta; Gatti, Giuseppe; Pappalardo, Aniello; Benussi, Bernardo; Dreas, Lorella; Lattuada, Luca

doi:10.1016/j.ejcts.2006.02.001

Cited by 89 publications

(44 citation statements)

References 23 publications

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“…A single-dose crystalloid solution (Custodiol-HTK ® solution; Essential Pharma, Newtown, PA, United States of America) was sometimes preferred, especially when longer ischemic times were expected [16]. Off-pump and beating heart onpump techniques were adopted only in the presence of a diffusely calcified ascending aorta (confirmed by epiaortic ultrasonography scanning) to avoid the risk of cracking atherosclerotic plaques by the aortic crossclamp [17].…”

Section: Surgerymentioning

confidence: 99%

Predictors of immediate and long-term outcomes of coronary bypass surgery in patients with left ventricular dysfunction

et al. 2015

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Despite encouraging improvements, outcomes of coronary artery bypass grafting (CABG) in the presence of left ventricular (LV) dysfunction remain poor. In the present study, the authors' experience on this subject was reviewed to establish the predictors of immediate and long-term results of surgery. Out of 4383 consecutive patients with multivessel coronary artery disease who underwent primary isolated CABG at the authors' institution from January 1999 throughout September 2014, 300 patients (mean age 66.1 ± 9.6 years) suffered preoperatively from LV dysfunction (defined as LV ejection fraction ≤35 %). The mean expected operative risk (EuroSCORE II) was 10.3 ± 13 %. Hospital deaths and perioperative complications were analyzed retrospectively. Outcomes were evaluated during a mean follow-up of 6.2 ± 4 years. None, one or both internal thoracic arteries (ITAs) were used in 6.3, 29 and 64.7 % of cases, respectively. There were 16 (5.3 %) hospital deaths. Prolonged invasive ventilation (17.7 %), acute kidney injury (14.7 %) and multiple blood transfusion (21.3 %) were the most frequent major postoperative complications. The 10-year non-parametric estimates of freedom from all-cause death, cardiac death, and major adverse cardiac and cerebrovascular events (MACCEs) were 47.8 [95 % confidence interval (CI) 44.1-51.5], 65.3 (95 % CI 61.4-69.2), and 42.3 % (95 % CI 38.3-46.3), respectively. Shared predictors of decreased late survival and MACCEs were old age (P < 0.04), chronic lung disease (P < 0.01), chronic dialysis (P < 0.0001) and extracardiac arteriopathy (P < 0.045). After adjustment for corresponding risk factors, freedom from cardiac death was higher when both ITAs were used but only for patients with significant increase of LV ejection fraction early after surgery (P = 0.04). In patients with LV dysfunction, CABG may be performed with acceptable hospital mortality and long-term survival. Late outcomes depend mainly on preoperative characteristics of the patients. The use of both ITAs for myocardial revascularization may give long-term survival benefits but only for patients whose LV function improves significantly early after surgery.

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Section: Surgerymentioning

confidence: 99%

Predictors of immediate and long-term outcomes of coronary bypass surgery in patients with left ventricular dysfunction

et al. 2015

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“…A higher prevalence of atheromas has generally been detected when epiaortic scanning was systematically used [6,7]. We found at least 1 of 12 ascending aortic segments with severe atheromas in 21.4% of 690 nearly consecutive, unselected patients submitted to epiaortic scan [11]. Quite pertinent to this discussion, that rate rose to 54.1% in the subset of combined aortic valve replacement and CABG, largely higher than in any other procedural subset.…”

Section: Discussionmentioning

confidence: 83%

“…Several studies have established the role of the atherosclerotic aorta as a precursor of brain embolism during cardiac operations [2][3][4]6,7,11,12]. It is worth emphasizing that stroke rates as high as 7.4-8.4% have been recorded following combined valve and coronary procedures in otherwise unselected patients managed according to aortic palpation [13,14].…”

Section: Discussionmentioning

confidence: 99%

“…What rates would be observed as a consequence of casual aortic manipulation in selected patients with ascending aortic atherosclerosis undergoing valve surgery is only subject to speculation as it has never been reported, nor will it likely ever be. Thus, both the prevalence of the disease and its role as a precursor of perioperative embolism [2], and of perioperative strokes in particular [2][3][4]6,7,11,12], point to the importance of accurate screening and proper surgical management of this condition. In fact, no operative complication carries more devastating sequelae than stroke, which also heavily contributes to operative mortality [11,13,14].…”

Section: Discussionmentioning

confidence: 99%

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Diagnosis and management of severe atherosclerosis of the ascending aorta and aortic arch during cardiac surgery: focus on aortic replacement

Zingone¹,

Rauber²,

Gatti³

et al. 2007

European Journal of Cardio-Thoracic Surgery

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“…Complications associated with manipulation of the aorta might be reduced by thorough evaluation of the ascending aorta using intraoperative monitoring to identify mobile atheromatous plaques and to detect safe areas for cannulation. Transesophageal echocardiography (TEE) and epiaortic ultrasound are the promising monitoring modalities to reduce the incidence of neurologic complications [43,44]. Manipulation of the aorta also can be decreased by the avoidance of additional partial clamp for constructing proximal anastomosis [45] or aorta no-touch technique [46].…”

Section: Prevention Of Emboli From Aortic Plaque and Intraoperative Mmentioning

confidence: 99%

Stroke associated with coronary artery bypass grafting

Arai

2015

Gen Thorac Cardiovasc Surg

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While coronary artery bypass grafting (CABG) has been playing a significant role in the revascularization for ischemic heart disease, neurological complications associated with CABG have been a primary concern. Stroke, although the incidence is low, is one of the most devastating complication of CABG. Many studies have identified the risk factors for stroke with CABG, such as prior stroke, carotid artery stenosis, aortic atherosclerosis, atrial fibrillation and cardiopulmonary bypass. Various rational approaches focusing on individual risk factor have been proposed for the stroke. Prophylactic carotid revascularization is an important strategy, and the diagnosis of carotid stenosis has to be established correctly. Prevention of emboli from aortic plaque is also an essential issue. Intraoperative monitoring with transesophageal or epiaortic ultrasound is useful to identify mobile atheromatous plaques and to select appropriate aortic manipulations. Maintenance of cerebral blood flow and blood pressure during cardiopulmonary bypass might be critical issues. Besides, there are conflicting two opinions regarding off-pump CABG; one supports an efficiency for the prevention of stroke while the other advocates no effect. This discrepancy might be explained by the difference of the risk of stroke in the population of the individual study and by the variation of the percentage of aortic clamping or aortic anastomosis in each study. Pharmaceutical therapies such as statin, preventive medication for atrial fibrillation, or antiplatelet are promising methods. Although it is hard to decrease the incidence of the stroke with any single countermeasure, sustained effort should be continued to overcome the stroke associated with CABG.

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The impact of epiaortic ultrasonographic scanning on the risk of perioperative stroke

Abstract: The use of epiaortic scanning is associated with a lower risk of intraoperative adverse events leading to early postoperative stroke.

Cited by 89 publications

References 23 publications

Predictors of immediate and long-term outcomes of coronary bypass surgery in patients with left ventricular dysfunction

Predictors of immediate and long-term outcomes of coronary bypass surgery in patients with left ventricular dysfunction

Diagnosis and management of severe atherosclerosis of the ascending aorta and aortic arch during cardiac surgery: focus on aortic replacement

Stroke associated with coronary artery bypass grafting

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