Ascending aortic atherosclerosis--a complex and challenging problem for the cardiac surgeon

Area of Science:

• Cardiovascular Surgery
• Vascular Medicine
• Neurosurgery

Background:

• Ascending aortic atherosclerosis is a growing concern in cardiac surgery.
• It is a primary risk factor for perioperative stroke and postoperative neurobehavioral changes.
• Patients with this condition face reduced survival and long-term embolic stroke risk.

Purpose of the Study:

• To highlight the clinical significance of ascending aortic atherosclerosis in cardiac surgery.
• To discuss diagnostic challenges and the role of intraoperative epiaortic ultrasound.
• To review current and emerging management strategies for this condition.

Main Methods:

• Review of current literature on ascending aortic atherosclerosis.
• Discussion of diagnostic modalities, emphasizing intraoperative epiaortic ultrasound.
• Analysis of surgical management options, including "no touch" techniques, modified grafting, and embolic protection.

Main Results:

• Preoperative noninvasive and manual intraoperative assessments are insufficient for diagnosing aortic atherosclerosis.
• Intraoperative epiaortic ultrasound is a sensitive tool for detecting atherosclerosis and guiding surgical decisions.
• Various surgical strategies exist, from minimally invasive approaches to aortic replacement or endarterectomy.

Conclusions:

• Increased awareness and accurate diagnosis of ascending aortic atherosclerosis are crucial for cardiac surgery.
• Intraoperative epiaortic ultrasound significantly enhances diagnostic capabilities.
• Tailored management strategies are essential to mitigate stroke risk and improve patient outcomes.