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Significantly reduced incidence of stroke during coronary artery bypass grafting using transesophageal
Insights
Transesophageal echocardiography (TEE) identified thoracic aortic atheromas, a stroke source in cardiac surgery. Modifying surgical techniques after TEE evaluation significantly reduced stroke rates in patients undergoing coronary artery bypass grafting (CABG).
Area of Science:
- Cardiovascular Surgery
- Neurology
- Diagnostic Imaging
Background:
- Protruding atheromas in the thoracic aorta are a significant source of systemic emboli.
- These atheromas are a major cause of stroke, particularly following cardiac surgery.
- Intraoperative identification of aortic atherosclerosis is crucial for preventing embolic events.
Purpose of the Study:
- To prospectively identify thoracic aorta atherosclerosis using intraoperative transesophageal echocardiography (TEE).
- To investigate the influence of various risk factors on aortic disease.
- To evaluate the impact of modifying surgical techniques on stroke outcomes.
Main Methods:
- Transesophageal echocardiography (TEE) was performed on 792 patients undergoing coronary artery bypass grafting (CABG).
- Surgical modifications, including hypothermic circulatory arrest with aortic arch atherectomy and off-pump CABG, were implemented based on TEE findings.
- Stroke rates were determined and analyzed in relation to surgical interventions and patient risk factors.
Main Results:
- No strokes occurred in 114 patients with grade II and III atheromas who underwent surgical modifications.
- The overall stroke rate in the study cohort was 0.76% (6 patients).
- Age, diabetes, triglycerides, VLDL, carotid artery disease, and chest X-ray calcium were identified as significant risk factors and predictors.
Conclusions:
- Intraoperative TEE is an essential tool for assessing the thoracic aorta during cardiac surgery.
- Identifying aortic atheromas via TEE and subsequently modifying surgical techniques leads to a significant reduction in stroke incidence.
- Proactive management of aortic atherosclerosis during CABG improves patient outcomes by mitigating stroke risk.
Objective:
Protruding atheromas of thoracic aorta have been identified as a source of systemic emboli and a major cause of stroke following cardiac surgery. This prospective study used transesophageal echocardiography (TEE) to identify atherosclerosis of thoracic aorta intraoperatively. The influence of risk factors was studied. Finally the impact of modifying surgical technique on the outcome was evaluated.
Methods:
Seven-hundred and ninety-two patients undergoing coronary artery bypass grafting (CABG) were evaluated with TEE. Depending on the location and extent of thoracic aortic disease various surgical modifications were carried out, e.g. hypothermic circulatory arrest with aortic arch atherectomy, CABG on beating heart and others. The stroke rate in this group of patients was determined and analysed.
Results:
Of the 114 patients with grade II and III atheromas of aortic arch and ascending aorta in whom surgical modifications were done, none had stroke. The overall stroke rate in the study group was 0.76%, six patients had stroke. Stepwise logistic regression identified age, diabetes, serum triglycerides and VLDL as important risk factors. Associated carotid artery disease and calcium on chest X-ray (CXR) were identified as important predictors of disease.
Conclusions:
Intraoperative TEE is an invaluable modality for evaluating the thoracic aorta. There is significant reduction in stroke rate following identification of atheromas and modification of surgical technique.