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Updated: Mar 1, 2026
Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
[Prevention of cerebrovascular complications in coronary artery bypass grafting]
P A Mialiuk1, A V Marchenko1, V B Arutiunian1
1Federal Centre for Cardiovascular Surgery named after G.S. Sukhanov under the Ministry of Public Health of the Russian Federation, Perm, Russia.
Insights
Epiaortic scanning guides differentiated surgical approaches for coronary artery bypass grafting (CABG), significantly reducing stroke and mortality. This strategy enhances patient outcomes compared to conventional methods.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Diagnostic Imaging
Background:
- Coronary artery bypass grafting (CABG) carries risks of cerebrovascular complications.
- Conventional CABG often utilizes standard artificial circulation (AC) techniques.
- Epiaortic ultrasonography offers detailed aortic assessment for tailored surgical strategies.
Purpose of the Study:
- To compare the incidence of cerebrovascular complications after CABG using a differentiated approach guided by epiaortic scanning versus a standard conventional approach.
- To evaluate the impact of a differentiated surgical strategy on postoperative stroke and mortality rates.
Main Methods:
- A comparative analysis of 3,454 CABG operations.
- Study Group (n=765): Intraoperative epiaortic scanning determined surgical technique (CABG with AC, single clamp, on-pump beating-heart, no-touch aorta).
- Control Group (n=2,689): Standard CABG with AC.
Main Results:
- The Study Group showed a significantly lower mortality rate (0.3%) and zero ischaemic strokes compared to the Control Group (1.4% mortality, 1.4% stroke incidence).
- Perioperative infarction rates were similar between groups (0.7% Study Group vs. 0.6% Control Group).
- The differentiated approach based on epiaortic scanning findings led to a statistically significant reduction in ischaemic strokes and mortality.
Conclusions:
- A differentiated approach to CABG, informed by epiaortic scanning, significantly reduces postoperative ischaemic stroke and mortality.
- Intraoperative epiaortic ultrasonography enables personalized surgical decision-making for improved CABG outcomes.
- This strategy offers a safer alternative for patients undergoing CABG, particularly those with aortic atherosclerosis.
Abstract:
The authors carried out a comparative analysis of the incidence rate of cerebrovascular complications following coronary artery bypass grafting performed using either a differentiated approach to surgical policy depending on the findings of epiaortic ultrasonographic scanning or the standard conventional approach. A total of 3,454 operations of coronary artery bypass grafting were performed. All patients were divided into two groups. Patients of the Study Group (n=765) were subjected to obligatory intraoperative epiaortic scanning, with the variant of further surgical intervention depending on the obtained findings of the examination. The Control Group patients (n=2,689) underwent standard coronary artery bypass grafting in the conditions of artificial circulation (AC). In the Study Group patients, depending on the degree and localization of the atherosclerotic lesion of the aorta, determined by the findings of epiaortic scanning, one of the following techniques of coronary artery bypass grafting (CABG) was chosen: cases with no lesion were managed by CABG with AC (585 patients); a local solitary lesion was managed by altering the site of cannulation and application of the clamp (92 patients) or by the operation according to the 'single clamp' technique (43 patients); cases of manifested atherosclerosis of the ascending aorta were treated by the 'on-pump beating-heart' technique in the conditions of AC without placing clamps (27 patients); cases of massive involvement of the ascending aorta and aortic arch were managed by CABG performed according to the 'no-touch aorta' technique (18 patients). The total mortality rate amounted to 1.1%. Thirty-three (0.96%) patients in the postoperative period were found to have ischaemic stroke. The mortality rate in the Control Group amounted to 1.4% and that in the Study Group equalled 0.3%, with the number of cases of ischaemic strokes amounting to 33 (1.4%) and 0, respectively. Perioperative infarction was diagnosed in 16 (0.6%) cases in the Control Group and in 5 (0.7%) patients in the group treated using the differentiated approach. A conclusion was drawn that the differentiated approach to choosing the technique of CABG based on the findings obtained by means of epiaortic scanning was associated with a statistically significant decrease in both the number of ischaemic strokes and the mortality rate after CABG operations.
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