title: Routine intraoperative transesophageal echocardiography identifies patients with atheromatous aortas: impact on "off-pump" coronary artery bypass and perioperative stroke.
abstract: 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.
authors.affiliation: New York University Medical Center, New York 10016, USA. grossi@cv.med.nyu.edu
authors.forename: Eugene A
authors.initials: EA
authors.lastname: Grossi
authors.forename: Costas S
authors.initials: CS
authors.lastname: Bizekis
authors.forename: Ram
authors.initials: R
authors.lastname: Sharony
authors.forename: Paul C
authors.initials: PC
authors.lastname: Saunders
authors.forename: Aubrey C
authors.initials: AC
authors.lastname: Galloway
authors.forename: Angelo
authors.initials: A
authors.lastname: Lapietra
authors.forename: Robert M
authors.initials: RM
authors.lastname: Applebaum
authors.forename: Rick A
authors.initials: RA
authors.lastname: Esposito
authors.forename: Greg H
authors.initials: GH
authors.lastname: Ribakove
authors.forename: Alfred T
authors.initials: AT
authors.lastname: Culliford
authors.forename: Marc
authors.initials: M
authors.lastname: Kanchuger
authors.forename: Itzhak
authors.initials: I
authors.lastname: Kronzon
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Colvin
mesh_terms: 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*