title: Efficacy of intraoperative epiaortic ultrasound scanning for preventing stroke after coronary artery bypass surgery.
abstract: OBJECTIVE
  The aim of this study was to clarify the efficacy of intraoperative epiaortic ultrasound scanning (EAS) for preventing cerebral emboli following coronary artery bypass grafting (CABG).
  
  
  METHODS
  The intraoperative EAS was used to evaluate the ascending aorta in 909 consecutive CABG patients. When the scanning documented more than 3 mm of atheromatous thickness or plaque in the ascending aorta, we never manipulated it. Therefore 196 patients (21.6%) underwent off-pump CABG using composite grafts (85 cases, 9.4%) or in situ grafts (111 cases, 12.2%) with no aortic manipulation. The ascending aorta was confirmed to be free from significant atheromatous plaque by the EAS in 713 patients (78.4%). On-pump CABG was performed using aortic cannulation and total aortic clamping in 429 patients (47.2%). Off-pump CABG with aortocoronary bypass grafts was performed using side-bite aortic clamping in 165 cases (18.2%) or the other anastomotic devices in 63 cases (6.9%).
  
  
  RESULTS
  There were five hospital deaths (0.6%) but no postoperative strokes. Postoperative coronary angiography revealed 98.8% (1,659/1,680) of the patency of the bypassed grafts.
  
  
  CONCLUSIONS
  It was suggested that the application of aortic clamping or cardiopulmonary bypass was not a risk factor of cerebral emboli when the ascending aorta was evaluated using the EAS. Furthermore, the application of aortic clamping with free grafts may provide eligible bypass graft patterns, leading to sufficient graft patency.
authors.affiliation: Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Yamaguchi
authors.forename: Hideo
authors.initials: H
authors.lastname: Adachi
authors.forename: Masashi
authors.initials: M
authors.lastname: Tanaka
authors.forename: Takashi
authors.initials: T
authors.lastname: Ino
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000000981:diagnostic imaging*; D001018:Aortic Diseases / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality; D003250:Constriction; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000401:mortality; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D020766:Intracranial Embolism / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D020521:Stroke / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D014654:Vascular Patency