| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
J Thorac Cardiovasc Surg 2003;126:391-400
© 2003 The American Association for Thoracic Surgery
Surgery for acquired cardiovascular disease |
a Department of Cardiac Surgery, Innsbruck University Hospital, Innsbruck, Austria
Received for publication July 24, 2002; revisions received September 10, 2002; revisions received October 28, 2002; accepted for publication November 1, 2002.
* Address for reprints: Herbert Bernd Hangler, MD, Department of Cardiac Surgery, Innsbruck University Hospital, Anichstrasse 35, 6020, Innsbruck, Austria
herbert.hangler{at}uibk.ac.at
OBJECTIVE: Use of epiaortic scanning in coronary surgery is still a matter of debate. It is unclear whether the findings obtained by epiaortic scanning lead to effective changes in surgical technique that may reduce stroke rates.
METHODS: Epiaortic scanning was performed in 352 patients undergoing primary coronary artery bypass grafting before opening the pericardium using a 7.5-MHz ultrasonic probe. In the presence of moderate atherosclerosis (maximum aortic wall thickness of 3 to 5 mm), primarily single aortic crossclamping was carried out. In cases of severe sclerosis (maximum aortic wall thickness > 5 mm), aortic no-touch techniques on the beating heart were used.
RESULTS: The degree of ascending aortic atherosclerosis was normal or mild in 151 patients (42.9%), moderate in 167 patients (47.5%), and severe in 34 patients (9.6%). The operative technique was modified in 31.1% of patients with moderate aortic sclerosis and in 91.2% of patients with severe aortic sclerosis. Perioperative mortality was 0.0% for mild disease, 3.0% for moderate disease, and 8.8% for severe disease (P = .005). Corresponding stroke rates reached 2.0%, 2.4%, and 2.9% (P = .935). Logistic regression adjusting for EuroSCORE showed that ascending aortic atherosclerosis was an independent predictor of perioperative mortality (P = .013, odds ratio 1.67, confidence interval 1.11-2.50). The influence of aortic disease on the stroke prevalence was probably due to chance (P = .935), demonstrating a potentially positive effect of operative modifications concerning stroke caused by aortic manipulation.
CONCLUSIONS: We conclude that intraoperative screening of coronary artery bypass grafting patients by epiaortic scanning can reveal useful information about the operative risk and with an aortic no-touch concept, perioperative stroke rates in high-risk patients may be lower than predicted.
This article has been cited by other articles:
|
|
 |
|
  L. R. Caplan Translating What Is Known About Neurological Complications of Coronary Artery Bypass Graft Surgery Into Action Arch Neurol, September 1, 2009; 66(9): 1062 - 1064. [Full Text] [PDF]
|
|
|
|
 |
|
 Y. Takami, K. Tajima, S. Terazawa, N. Okada, K. Fujii, and Y. Sakai Safer aortic crossclamping during short-term moderate hypothermic circulatory arrest for cardiac surgery in patients with a bad ascending aorta J. Thorac. Cardiovasc. Surg., April 1, 2009; 137(4): 875 - 880. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. S. Whitley and K. E. Glas An Argument for Routine Ultrasound Screening of the Thoracic Aorta in the Cardiac Surgery Population Seminars in Cardiothoracic and Vascular Anesthesia, December 1, 2008; 12(4): 290 - 297. [Abstract] [PDF]
|
|
|
|
 |
|
 K. E. Glas, M. Swaminathan, S. T. Reeves, J. S. Shanewise, D. Rubenson, P. K. Smith, J. P. Mathew, S. K. Shernan, and Council for Intraoperative Echocardiography of the Guidelines for the Performance of a Comprehensive Intraoperative Epiaortic Ultrasonographic Examination: Recommendations of the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists; Endorsed by the Society of Thoracic Surgeons Anesth. Analg., May 1, 2008; 106(5): 1376 - 1384. [Full Text] [PDF]
|
|
|
|
 |
|
 M. Nakamura, F. Okamoto, K. Nakanishi, R. Maruyama, A. Yamada, S. Ushikoshi, S. Terasaka, S. Kuroda, K. Sakai, and T. Higami Does Intensive Management of Cerebral Hemodynamics and Atheromatous Aorta Reduce Stroke After Coronary Artery Surgery? Ann. Thorac. Surg., February 1, 2008; 85(2): 513 - 519. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Rosenberger, S. K. Shernan, M. Loffler, P. S. Shekar, J. A. Fox, J. K. Tuli, M. Nowak, and H. K. Eltzschig The Influence of Epiaortic Ultrasonography on Intraoperative Surgical Management in 6051 Cardiac Surgical Patients Ann. Thorac. Surg., February 1, 2008; 85(2): 548 - 553. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. G. Wolf, Y. Abu-Omar, B. P. Choudhary, D. Pigott, and D. P. Taggart Gaseous and solid cerebral microembolization during proximal aortic anastomoses in off-pump coronary surgery: The effect of an aortic side-biting clamp and two clampless devices J. Thorac. Cardiovasc. Surg., February 1, 2007; 133(2): 485 - 493. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Bonatti, W. J. van Boven, G. Nagele, G. Shahin, T. Schachner, G. Laufer, P. Bergman, J. van der Linden, and The AORTIC Study Group (Assessment Of the Risk of Do particulate emboli from the ascending aorta in coronary bypass grafting correlate with aortic wall thickness? Interactive CardioVascular and Thoracic Surgery, December 1, 2006; 5(6): 716 - 720. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Royse and C. Royse A standardised intraoperative ultrasound examination of the aorta and proximal coronary arteries Interactive CardioVascular and Thoracic Surgery, December 1, 2006; 5(6): 701 - 704. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Zingone, G. Gatti, E. Rauber, A. Pappalardo, B. Benussi, and L. Dreas Surgical Management of the Atherosclerotic Ascending Aorta: Is Endoaortic Balloon Occlusion Safe? Ann. Thorac. Surg., November 1, 2006; 82(5): 1709 - 1714. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Takami and H. Masumoto Brain magnetic resonance angiography-based strategy for stroke reduction in coronary artery bypass grafting Interactive CardioVascular and Thoracic Surgery, August 1, 2006; 5(4): 383 - 386. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. Zingone, E. Rauber, G. Gatti, A. Pappalardo, B. Benussi, L. Dreas, and L. Lattuada The impact of epiaortic ultrasonographic scanning on the risk of perioperative stroke. Eur. J. Cardiothorac. Surg., May 1, 2006; 29(5): 720 - 728. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. M. McKhann, M. A. Grega, L. M. Borowicz Jr, W. A. Baumgartner, and O. A. Selnes Stroke and Encephalopathy After Cardiac Surgery: An Update Stroke, February 1, 2006; 37(2): 562 - 571. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. F. Aranki, M. Nathan, P. Shekar, G. Couper, R. Rizzo, and L. H. Cohn Hypothermic Circulatory Arrest Enables Aortic Valve Replacement in Patients With Unclampable Aorta Ann. Thorac. Surg., November 1, 2005; 80(5): 1679 - 1687. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Ruel, E. J. Suuronen, J. Song, V. Kapila, D. Gunning, G. Waghray, F. D. Rubens, and T. G. Mesana Effects of off-pump versus on-pump coronary artery bypass grafting on function and viability of circulating endothelial progenitor cells J. Thorac. Cardiovasc. Surg., September 1, 2005; 130(3): 633 - 639. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Schachner, A. Zimmer, G. Nagele, G. Laufer, and J. Bonatti Risk factors for late stroke after coronary artery bypass grafting J. Thorac. Cardiovasc. Surg., August 1, 2005; 130(2): 485 - 490. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. G Raja and G. D Dreyfus Will off-pump coronary artery surgery replace conventional coronary artery surgery? J R Soc Med, June 1, 2004; 97(6): 275 - 278. [Full Text] [PDF]
|
|
|
|
|
|
S. Das and J. Dunning Can epiaortic ultrasound reduce the incidence of intraoperative stroke during cardiac surgery? Interactive CardioVascular and Thoracic Surgery, March 1, 2004; 3(1): 71 - 75. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
