Department of Anesthesiology

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Severity of aortic atheromatous disease diagnosed by transesophageal echocardiography predicts stroke and other outcomes associated with coronary artery surgery: a prospective study.

TitleSeverity of aortic atheromatous disease diagnosed by transesophageal echocardiography predicts stroke and other outcomes associated with coronary artery surgery: a prospective study.
Publication TypeJournal Article
Year of Publication1996
AuthorsHartman GS, Yao FS, Bruefach M, Barbut D, Peterson JC, Purcell MH, Charlson ME, Gold JP, Thomas SJ, Szatrowski TP
JournalAnesth Analg
Volume83
Issue4
Pagination701-8
Date Published1996 Oct
ISSN0003-2999
KeywordsAged, Aorta, Thoracic, Aortic Diseases, Arteriosclerosis, Blood Pressure, Cardiopulmonary Bypass, Cerebrovascular Disorders, Coronary Artery Bypass, Echocardiography, Transesophageal, Female, Follow-Up Studies, Forecasting, Humans, Intraoperative Care, Male, Myocardial Infarction, Postoperative Complications, Prospective Studies, Risk Factors, Single-Blind Method, Surgical Procedures, Elective, Survival Rate, Treatment Outcome
Abstract

Advanced atheromatous disease of the thoracic aorta identified by transesophageal echocardiography (TEE) is a major risk factor for perioperative stroke. This study investigated whether varying degrees of atherosclerosis of the descending aorta, as assessed by TEE, are an independent predictor of cardiac and neurologic outcome in patients undergoing coronary artery bypass grafting (CABG). Intraoperative TEE of the descending aorta was performed on 189 of 248 patients participating in a randomized controlled trial of low (50-60 mm Hg) or high (80-100 mm Hg) mean arterial pressure during cardiopulmonary bypass for elective CABG. Aortic atheromatous disease was graded from I to V in order of increasing severity by observers blinded to outcome. Measured outcomes were death, stroke, and major cardiac events assessed at 1 wk and 6 mo. Nine of the 189 patients with TEE examinations had perioperative strokes by 1 wk. At 1 wk, no strokes had occurred in the 123 patients with atheroma Grades I or II, while the 1-wk stroke rate was 5.5% (2/36), 10.5% (2/19), and 45.5% (5/11) for Grades III, IV, and V, respectively (Fisher's exact test, P = 0.00001). For 6-mo outcome, advancing aortic atheroma grade was a univariate predictor of stroke (P = 0.00001) and death (P = 0.03). By 6 mo there were one additional stroke, three additional deaths, and one additional major cardiac event. Atheromatous disease of the descending aorta was a strong predictor of stroke and death after CABG. TEE determination of atheroma grade is a critical element in the management of patients undergoing CABG surgery.

Alternate JournalAnesth. Analg.
PubMed ID8831306
Grant ListHL44719 / HL / NHLBI NIH HHS / United States