Significantly reduced incidence of stroke during coronary artery bypass grafting using transesophageal echocardiography.
OBJECTIVE
Protruding atheromas of thoracic aorta have been identified as a source of systemic emboli and a major cause of stroke following cardiac surgery. This prospective study used transesophageal echocardiography (TEE) to identify atherosclerosis of thoracic aorta intraoperatively. The influence of risk factors was studied. Finally the impact of modifying surgical technique on the outcome was evaluated.


METHODS
Seven-hundred and ninety-two patients undergoing coronary artery bypass grafting (CABG) were evaluated with TEE. Depending on the location and extent of thoracic aortic disease various surgical modifications were carried out, e.g. hypothermic circulatory arrest with aortic arch atherectomy, CABG on beating heart and others. The stroke rate in this group of patients was determined and analysed.


RESULTS
Of the 114 patients with grade II and III atheromas of aortic arch and ascending aorta in whom surgical modifications were done, none had stroke. The overall stroke rate in the study group was 0.76%, six patients had stroke. Stepwise logistic regression identified age, diabetes, serum triglycerides and VLDL as important risk factors. Associated carotid artery disease and calcium on chest X-ray (CXR) were identified as important predictors of disease.


CONCLUSIONS
Intraoperative TEE is an invaluable modality for evaluating the thoracic aorta. There is significant reduction in stroke rate following identification of atheromas and modification of surgical technique.
Trehan
N
N
Escorts Heart Institute and Research Centre, New Delhi, India.
Mishra
M
M
Dhole
S
S
Mishra
A
A
Karlekar
A
A
Kohli
V M
VM
D000328:Adult; D000368:Aged; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D001161:Arteriosclerosis / Q000000981:diagnostic imaging / Q000601:surgery*; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000601:surgery*; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D002542:Intracranial Embolism and Thrombosis / Q000000981:diagnostic imaging / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000517:prevention & control*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors