Retrospective Analysis of Cerebral Complications After Coronary Artery Bypass Grafting in Elderly Patients

Abstract

The present study retrospectively investigated cerebral complications of coronary artery bypass grafting in 205 consecutive patients aged 70 years or older, who underwent elective cardiopulmonary bypass from 1990 to 1997. Computed tomography of the brain and chest was done before surgery. Ten patients had so-called 'aortic no-touch surgery' and suffered no cerebral complications; the other 195 patients had conventional surgery. Adverse cerebral events occurred in 8.7%, including cerebral infarction (4.1%), diffuse encephalopathy (1.0%), convulsions (1.0%), transient disturbance of consciousness (1.0%), and severe loss of volition (1.5%). Multivariate analysis showed that only the detection of calcification of the ascending aorta was significantly associated with cerebral complications (p = 0.029). Total clamping tended to be superior to partial clamping for prevention of cerebrovascular accidents. The mortality rate was 7.3%. In-hospital death was related to age (p = 0.0062), cerebral complications (p = 0.0032), and a low left-ventricular function (p = 0.018). Therefore, chest computed tomography to assess the ascending aorta should be performed preoperatively. Modified techniques like aortic no-touch surgery or other therapies combined with coronary intervention may be needed in elderly patients with severe calcification of the ascending aorta.

Clinical Outcome of Percutaneous Transluminal Coronary Rotational Atherectomy in Patients With End-Stage Renal Disease

“…In patients with two-vessel disease, treatment was selected on the basis of the patient's wishes and consideration of the perioperative risk (preoperative estimation of risk was done using the ACC/AHA Guidelines for CABG surgery and the history of cerebral infarction). 19,20 As a result, 14 patients with two-vessel disease underwent CABG.…”

Cerebral Embolism in Off-Pump Coronary Artery Bypass Grafting.

“…[2][3][4][5] Ura et al reported that flail atheromatous plaque can develop at the site of total or sidebiting clamping, even if the epiaortic echogram shows mild or moderate atheromatous change in the ascending aorta. 6,7 An atherosclerotic ascending aorta is closely related to carotid occlusive disease in CABG candidates, 8 and regardless of the degree of disease in the ascending aorta sidebiting clamps should be applied with great care. In the present case we had a choice of either the in-situ right gastroepiploic artery or a composite graft with the in-situ internal thoracic artery as a graft to the right coronary artery.…”

The role of computed tomography in pre-procedural planning of cardiovascular surgery and intervention

“…However, extensive atherosclerotic calcification of the ascending aorta (porcelain aorta) precludes cannulation due to associated high risk of plaque dislodgement that may result in cerebrovascular accidents. There is an 8.7 % risk of peri-operative stroke in patients with calcification compared with those without [6], which is the major cause of post-operative morbidity and mortality in cardiac surgery [7]. The risk is lower in complete than partial cross clamping during surgery [6].…”

“…There is an 8.7 % risk of peri-operative stroke in patients with calcification compared with those without [6], which is the major cause of post-operative morbidity and mortality in cardiac surgery [7]. The risk is lower in complete than partial cross clamping during surgery [6]. Calcification can be evaluated in axial images or sagittal reformatted images or volume rendered images (Fig.…”