Routine intraoperative transesophageal echocardiography identifies patients with atheromatous aortas: impact on "off-pump" coronary artery bypass and perioperative stroke.
BACKGROUND
Patients with severe atheromatous aortic disease (AAD) undergoing coronary artery bypass grafting (CABG) have increased operative risks. The "off-pump" CABG (OPCAB) technique was evaluated in patients given the diagnosis of severe AAD by routine transesophageal echocardiography.


METHODS
A total of 5737 patients underwent CABG, with 913 having transesophageal echocardiography findings of severe AAD. Of the patients with severe AAD, 678 (74.3%) had conventional CABG and 235 (25.7%) had OPCAB.


RESULTS
Hospital mortality was 8.7% for conventional CABG and 5.1% for OPCAB (P =.08). Multivariate analysis revealed that increased mortality was significantly associated with acute myocardial infarction, conventional CABG, age, renal disease, history of stroke, and ejection fraction < 30%. Neurologic complications occurred in 6.3% of patients undergoing CABG and in 2.1% undergoing OPCAB (P =.01). Freedom from any complication was significantly greater with OPCAB.


CONCLUSIONS
Routine intraoperative transesophageal echocardiography identifies patients with severe AAD. In these patients, OPCAB technique is associated with a lower risk of death, stroke, and all complications.
Grossi
Eugene A
EA
New York University Medical Center, New York 10016, USA. grossi@cv.med.nyu.edu
Bizekis
Costas S
CS
Sharony
Ram
R
Saunders
Paul C
PC
Galloway
Aubrey C
AC
Lapietra
Angelo
A
Applebaum
Robert M
RM
Esposito
Rick A
RA
Ribakove
Greg H
GH
Culliford
Alfred T
AT
Kanchuger
Marc
M
Kronzon
Itzhak
I
Colvin
Stephen B
SB
D000368:Aged; D001018:Aortic Diseases / Q000000981:diagnostic imaging*; D001161:Arteriosclerosis / Q000000981:diagnostic imaging*; D016022:Case-Control Studies; D001026:Coronary Artery Bypass / Q000379:methods / Q000401:mortality; D017548:Echocardiography, Transesophageal; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D015999:Multivariate Analysis; D009422:Nervous System Diseases / Q000453:epidemiology*; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology*