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Intraoperative Epi-Aortic Scans Reduce Adverse Neurological Sequelae in Elderly, High Risk Patients Undergoing
Suvitesh Luthra1, Miguel M Leiva Juarez2, Zaheer Tahir1
1Division of Cardiac Surgery, Derriford Hospital, Plymouth, Devon, UK.
Insights
Intraoperative epi-aortic scanning significantly reduces neurological complications after coronary artery bypass surgery (CABG). This technique is especially beneficial for elderly patients and those with high surgical risk scores.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Medical Imaging
Background:
- Coronary artery bypass grafting (CABG) surgery carries risks of neurological complications due to aortic manipulation.
- Atherosclerotic disease in the aorta is a primary concern during CABG procedures.
- Minimizing neurological sequelae is crucial for improving patient outcomes post-CABG.
Purpose of the Study:
- To evaluate the effectiveness of intraoperative epi-aortic scanning in reducing neurological sequelae after CABG.
- To identify specific patient subgroups that benefit most from this scanning technique.
Main Methods:
- Retrospective review of 1,989 patients undergoing first-time CABG.
- Stratification into groups with and without intraoperative epi-aortic scanning.
- Statistical analysis including logistic regression and CUSUM plots to assess outcomes and predictors.
Main Results:
- Epi-aortic scanning was an independent predictor of reduced adverse neurological events (OR: 0.29).
- Lower rates of stroke, confusional state, and combined events were observed in scanned patients.
- Cumulative summation (CUSUM) scores indicated greater benefit in patients over 70 or with logistic Euroscore >2.
Conclusions:
- Intraoperative epi-aortic scanning effectively assesses aortic atherosclerotic burden.
- This imaging technique can guide surgical strategy to decrease adverse neurological outcomes.
- High-risk and elderly patients particularly benefit from intraoperative epi-aortic scanning during CABG.
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, chi2 test, 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.
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