title: The influence of epiaortic ultrasonography on intraoperative surgical management in 6051 cardiac surgical patients.
abstract: BACKGROUND
  Intraoperative echocardiography has become a mainstay monitor of cardiac function and a popular diagnostic tool in patients undergoing cardiac procedures. Previous reports suggest that epiaortic ultrasonography (EU) is superior to transesophageal echocardiography and manual palpation in identifying ascending aortic atheroma. Its impact on surgical decision making has not been thoroughly investigated, however.
  
  
  METHODS
  We retrospectively analyzed the medical records of 6051 consecutive patients who underwent EU of their ascending aorta during cardiac operations between 1996 and 2006 to determine a potential impact on intraoperative surgical decision making. Aortic atheroma was graded according to standard classification. Neurologic complications were evaluated according to the Society of Thoracic Surgeon definition for stroke and transient ischemic attack (TIA).
  
  
  RESULTS
  The overall impact of EU on surgical decision making was 4.1% and included a change in the technique for inducing cardiac arrest in 1.8%, aortic atherectomy or replacement surgery in 0.8%, requirement for off-pump coronary artery bypass grafting (CABG) in 0.6%, avoidance of aortic cross-clamping and use of ventricular fibrillatory arrest in 0.5%, change in arterial cannulation site in 0.2%, or avoidance of aortic cannulation in 0.2%. The greatest affect of EU was observed in patients undergoing combined CABG with aortic/mitral valve procedures (6.7%). The smallest impact was seen in patients undergoing mitral valve operations (1.4%). Aortic atheroma was more frequent on the anterior aspect of the aorta (n = 171) in patients with a change in surgical plan than on the posterior aspect (n = 78). The overall stroke rate was lower in patients with intraoperative EU compared with all patients undergoing surgical procedures.
  
  
  CONCLUSIONS
  Epiaortic ultrasonography is a useful technique to detect ascending aortic atheroma, has a significant impact on surgical decision making in more than 4% of cardiac surgical patients, and might result in improved perioperative neurologic outcome.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Tübingen University Hospital, Tübingen, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Rosenberger
authors.forename: Stanton K
authors.initials: SK
authors.lastname: Shernan
authors.forename: Michaela
authors.initials: M
authors.lastname: Löffler
authors.forename: Prem S
authors.initials: PS
authors.lastname: Shekar
authors.forename: John A
authors.initials: JA
authors.lastname: Fox
authors.forename: Jayshree K
authors.initials: JK
authors.lastname: Tuli
authors.forename: Martina
authors.initials: M
authors.lastname: Nowak
authors.forename: Holger K
authors.initials: HK
authors.lastname: Eltzschig
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000601:surgery; D002648:Child; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D015994:Incidence; D002546:Ischemic Attack, Transient / Q000453:epidemiology* / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000601:surgery; D016343:Monitoring, Intraoperative / Q000379:methods; D011183:Postoperative Complications / Q000517:prevention & control; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D020521:Stroke / Q000453:epidemiology* / Q000517:prevention & control; D016019:Survival Analysis; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional