Does routine use of aortic ultrasonography decrease the stroke rate in coronary artery bypass surgery?

Abstract

These data indicate that intraoperative ultrasonography of the ascending aorta with simple modifications in operative technique reduces the stroke rate in CABG.

Hydrodynamic evaluation of axillary artery perfusion for normal and diseased aorta

“…1,2 Nowadays, cardiac surgeons sometimes encounter patients with extensive atherosclerosis, multiple aortic aneurysms, and/or a severely atheromatous ascending aorta, called "shaggy aorta." 3 In these conditions, manipulation of the ascending aorta, including cannulation and clamping, may cause deleterious atheroembolism and should be avoided. 4,5 Retrograde perfusion from the femoral artery may induce paradoxical atheroembolism to the brain in patients with iliac artery atherosclerosis, an abdominal aortic aneurysm, and/or a descending aortic aneurysm.…”

ACC/AHA 2004 guideline update for coronary artery bypass graft surgery

“…The most common change in operative approach was use of a no-clamp, cold fibrillatory arrest technique. Three percent of the control group had strokes compared with none of the epivascular echo-managed group (P less than 0.02) (51).…”

“…Although palpation of the aorta has traditionally been used by surgeons to identify patients with atheromatous disease of the ascending aorta and to find "soft spots" for cannulation or cross-clamping, the use of ultrasound has been suggested as a more accurate means of assessing the aorta (51). Duda et al (51) have suggested that once aortic atherosclerosis is identified, alternative strategies to prevent mobilization of aortic atheroma should be considered, including techniques such as groin or subclavian placement of the aortic cannulas, fibrillatory arrest without aortic crossclamping, use of a single cross-clamp technique, modifying the placement of proximal anastomoses, or all-arterial revascularization in cases of severe aortic involvement. Other authors recommended ascending aortic replacement under circulatory arrest as the best means of minimizing this complication (52,53).…”

Review of intraoperative TOE

“…The information obtained may lead to a change in site of cannulation, cross clamp or proximal anastomoses or even avoidance of proximal anastomoses altogether. Such interventions have been shown to reduce the risk of adverse neurological events [11][12][13] .…”