TY - JOUR
T1 - Strategy for the reduction of stroke incidence in cardiac surgical patients
AU - Wareing, Thomas H.
AU - Davila-Roman, Victor G.
AU - Daily, Bill B.
AU - Murphy, Suzan F.
AU - Schechtman, Kenneth B.
AU - Barzilai, Benico
AU - Kouchoukos, Nicholas T.
N1 - Funding Information:
Supported in part by National Institutes of Health grant HL 17646 (SCOR in Coronary and Vascular Heart Disease), Bethesda, Maryland. We are grateful to Nikki Gratigny and Pamela Pigg for preparation of the manuscript and to Carlson Johnson, LPN, for assistance with the analysis of the data.
PY - 1993/6
Y1 - 1993/6
N2 - Atherosclerosis of the ascending aorta (AAA) and severe carotid artery disease are risk factors for stroke in cardiac surgical patients. Twelve hundred of a consecutive series of 1,334 patients 50 years of age or older having a cardiac operation were screened for the presence of AAA by intraoperative ultrasonographic scanning and for the presence of carotid artery occlusive disease (791 of 798 patients ≥65 years of age and younger symptomatic patients) by carotid duplex scanning. Coronary artery disease was present in 88% of the patients. Patients with moderate or severe AAA (n = 231; 19.3% of the total) were treated by ascending aortic replacement (n = 27) or by modified, less extensive techniques (n = 168) to avoid the atherosclerotic areas. Thirty-three patients had combined carotid endarterectomy and cardiac operation. Thirty-day mortality and stroke rates for the 1,200 patients were 4.0% and 1.6%, respectively. The stroke rate was low (1.1%) among the 969 patients with no or mild AAA. It was zero among 27 patients with moderate or severe AAA who had ascending aortic replacement and among the 33 patients who had carotid endarterectomy. The stroke rates were higher for 111 patients with moderate or severe ascending aortic disease who had only minor interventions (6.3%) and for 16 patients with severe carotid artery disease who did not have carotid endarterectomy (18.7%). Screening for AAA and carotid artery disease and aggressive surgical treatment of moderate or severe AAA and severe or symptomatic carotid artery disease appears to reduce the frequency of stroke in older cardiac surgical patients.
AB - Atherosclerosis of the ascending aorta (AAA) and severe carotid artery disease are risk factors for stroke in cardiac surgical patients. Twelve hundred of a consecutive series of 1,334 patients 50 years of age or older having a cardiac operation were screened for the presence of AAA by intraoperative ultrasonographic scanning and for the presence of carotid artery occlusive disease (791 of 798 patients ≥65 years of age and younger symptomatic patients) by carotid duplex scanning. Coronary artery disease was present in 88% of the patients. Patients with moderate or severe AAA (n = 231; 19.3% of the total) were treated by ascending aortic replacement (n = 27) or by modified, less extensive techniques (n = 168) to avoid the atherosclerotic areas. Thirty-three patients had combined carotid endarterectomy and cardiac operation. Thirty-day mortality and stroke rates for the 1,200 patients were 4.0% and 1.6%, respectively. The stroke rate was low (1.1%) among the 969 patients with no or mild AAA. It was zero among 27 patients with moderate or severe AAA who had ascending aortic replacement and among the 33 patients who had carotid endarterectomy. The stroke rates were higher for 111 patients with moderate or severe ascending aortic disease who had only minor interventions (6.3%) and for 16 patients with severe carotid artery disease who did not have carotid endarterectomy (18.7%). Screening for AAA and carotid artery disease and aggressive surgical treatment of moderate or severe AAA and severe or symptomatic carotid artery disease appears to reduce the frequency of stroke in older cardiac surgical patients.
UR - http://www.scopus.com/inward/record.url?scp=0027314803&partnerID=8YFLogxK
U2 - 10.1016/0003-4975(93)91079-3
DO - 10.1016/0003-4975(93)91079-3
M3 - Article
C2 - 8512388
AN - SCOPUS:0027314803
SN - 0003-4975
VL - 55
SP - 1400
EP - 1408
JO - The Annals of thoracic surgery
JF - The Annals of thoracic surgery
IS - 6
ER -