title: Intraoperative Epi-Aortic Scans Reduce Adverse Neurological Sequelae in Elderly, High Risk Patients Undergoing Coronary Artery Bypass Surgery - a Propensity Matched, Cumulative Sum Control Analysis.
abstract: BACKGROUND
  Adverse neurological sequelae are a major cause of morbidity and mortality after coronary artery bypass (CABG) surgery, due to manipulation of an atherosclerotic aorta. The purpose of this study is to measure the impact of intraoperative epi-aortic scanning in reducing neurologic sequelae after CABG, and the patient subgroups that are benefitted the most.
  
  
  METHODS
  Patients that underwent first-time CABG from July 2010 to March 2014 (n=1,989) were retrospectively reviewed and stratified by history of intraoperative epi-aortic scan (n=350) or no scan (n=1,639). Baseline characteristics, rates of adverse neurological events, and overall survival were compared among groups in both matched and unmatched cohorts and tested using Student's t-test, chi2test, or log-rank test, respectively. Multivariable analysis using logistic regression was performed to identify potential predictors for neurological sequelae. Cumulative summation plots (CUSUM) were constructed to display the number of preventable adverse neurological events per consecutive patient that underwent CABG. A p≤0.05 was considered statistically significant.
  
  
  RESULTS
  The use of epi-aortic scan (OR: 0.29, 95% CI: 0.09-0.99, p=0.48) was an independent predictor of adverse events. Overall rates of stroke (0.29% vs 0.55%), postoperative confusional state (1.43% vs 3.42%), or both (1.71% vs 3.72%) were lower in those scanned. CUSUM scores were higher in scanned patients, especially in those with an age above 70 years or logistic Euroscore >2.
  
  
  CONCLUSIONS
  Intraoperative epi-aortic scan is an effective assessment tool for atherosclerotic burden in the ascending aorta and can guide surgical strategy to decrease adverse neurological outcomes, particularly in high risk and elderly patients.
authors.affiliation: Division of Cardiac Surgery, Derriford Hospital, Plymouth, Devon, UK. Electronic address: drsl00@gmail.com.
authors.forename: Suvitesh
authors.initials: S
authors.lastname: Luthra
authors.affiliation: MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Miguel M
authors.initials: MM
authors.lastname: Leiva Juarez
authors.affiliation: Division of Cardiac Surgery, Derriford Hospital, Plymouth, Devon, UK.
authors.forename: Zaheer
authors.initials: Z
authors.lastname: Tahir
authors.affiliation: Division of Cardiac Surgery, New Cross Hospital, Wolverhampton, West Midlands, UK.
authors.forename: Patrick
authors.initials: P
authors.lastname: Yiu
mesh_terms: D000368:Aged; D001011:Aorta / Q000503:physiopathology*; D001026:Coronary Artery Bypass; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D009422:Nervous System Diseases / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D011183:Postoperative Complications / Q000503:physiopathology / Q000517:prevention & control*; D012307:Risk Factors; D015996:Survival Rate
keywords: Acute confusional syndrome; Coronary artery bypass surgery; Epi-aortic scan; Stroke