title: Assessment of ascending aorta using epiaortic ultrasonography during off-pump coronary artery bypass grafting.
abstract: BACKGROUND
  Use of an aortic partial clamp for proximal anastomosis during off-pump coronary artery bypass is known to increase the risk of fatal complications. The purpose of this study was to assess the management of the ascending aorta evaluated with epiaortic ultrasonography during off-pump coronary artery bypass.
  
  
  METHODS
  Intraoperative ultrasonography of the ascending aorta with a 10-MHz probe was performed consecutively in 155 patients undergoing off-pump coronary artery bypass between August 1999 and July 2001. The findings from ultrasonography, surgical modifications, and operative results were analyzed.
  
  
  RESULTS
  In 54 patients (34.8%), epiaortic ultrasonography showed atherosclerotic findings in the anterior side of the ascending aorta (group A). The remaining 101 patients had either normal findings or atherosclerotic findings in only the posterior side (group NA). A proximal anastomosis to the aorta was preoperatively planned in 117 patients (group A, 42; group NA, 75). In group A, a graft modification without clamping was implemented in 29 patients (24.8% of 117 patients), whereas the clamp site was modified to a different segment in 13 patients (11.1% of 117 patients). In all 75 patients in group NA, partial clamping was used in the standard fashion. There were no cerebral infarctions or operative deaths related to partial clamping. However, aortic dissection occurred in 1 patient in group NA.
  
  
  CONCLUSIONS
  In 35% of patients undergoing off-pump coronary artery bypass, epiaortic ultrasonography identified atherosclerotic findings in the anterior wall of the ascending aorta. This study suggests that revascularization without aortic manipulation during off-pump coronary artery bypass is indicated in as many as 25% of patients.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Fukuoka Tokushukai Hospital, Kasuga City, Fukuoka, Japan. tshimokawa-circ@umin.ac.jp
authors.forename: Tomoki
authors.initials: T
authors.lastname: Shimokawa
authors.forename: Naoki
authors.initials: N
authors.lastname: Minato
authors.forename: Noriko
authors.initials: N
authors.lastname: Yamada
authors.forename: Yuji
authors.initials: Y
authors.lastname: Takeda
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Hisamatsu
authors.forename: Manabu
authors.initials: M
authors.lastname: Itoh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000209:etiology; D001011:Aorta / Q000000981:diagnostic imaging*; D001018:Aortic Diseases; D001161:Arteriosclerosis / Q000000981:diagnostic imaging; D001026:Coronary Artery Bypass / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D014463:Ultrasonography