TY - JOUR
T1 - Stroke reduction
T2 - Diagnosis and management of the atheroclerotic ascending aorta during cardiac surgery
AU - Hogue, C. W.
AU - Barzilai, B.
AU - Davila-Roman, V. G.
PY - 1999/1/1
Y1 - 1999/1/1
N2 - Neurologic injury is the most devastating complication of cardiac surgery, and leads to excessive morbidity, mortality, and increased health care costs. Ascending aorta atherosclerosis is one of the most important risk factors for perioperative stroke, particularly in the elderly. As the number of elderly patients undergoing cardiac surgical procedures continues to increase, it is likely that the frequency of postoperative neurologic complications will increase as well. Strategies aimed toward the identification of high-risk patients include screening for carotid artery disease and ascending aorta atherosclerosis. Epiaortic ultrasound provides high-resolution images of the ascending aorta that allow for evaluation for the presence of atherosclerosis. Minor modifications in the operative technique based on the epiaortic ultrasound findings are easy to perform and require minimal training and relatively inexpensive equipment. Nonrandomized studies that use epiaortic ultrasound have reported perioperative stroke rates that are lower than those in which this approach is not used, suggesting that identification of high-risk patients and minor modifications in the operative technique may lower perioperative stroke rates without increasing operative risk. Prospective, randomized trials are needed to evaluate whether more aggressive changes in surgical techniques and/or the use of neuroprotective agents in high-risk patients may prevent neurologic complications associated with cardiac surgery.
AB - Neurologic injury is the most devastating complication of cardiac surgery, and leads to excessive morbidity, mortality, and increased health care costs. Ascending aorta atherosclerosis is one of the most important risk factors for perioperative stroke, particularly in the elderly. As the number of elderly patients undergoing cardiac surgical procedures continues to increase, it is likely that the frequency of postoperative neurologic complications will increase as well. Strategies aimed toward the identification of high-risk patients include screening for carotid artery disease and ascending aorta atherosclerosis. Epiaortic ultrasound provides high-resolution images of the ascending aorta that allow for evaluation for the presence of atherosclerosis. Minor modifications in the operative technique based on the epiaortic ultrasound findings are easy to perform and require minimal training and relatively inexpensive equipment. Nonrandomized studies that use epiaortic ultrasound have reported perioperative stroke rates that are lower than those in which this approach is not used, suggesting that identification of high-risk patients and minor modifications in the operative technique may lower perioperative stroke rates without increasing operative risk. Prospective, randomized trials are needed to evaluate whether more aggressive changes in surgical techniques and/or the use of neuroprotective agents in high-risk patients may prevent neurologic complications associated with cardiac surgery.
UR - http://www.scopus.com/inward/record.url?scp=0033024559&partnerID=8YFLogxK
U2 - 10.1177/108925329900300104
DO - 10.1177/108925329900300104
M3 - Article
AN - SCOPUS:0033024559
SN - 1089-2532
VL - 3
SP - 17
EP - 24
JO - Seminars in Cardiothoracic and Vascular Anesthesia
JF - Seminars in Cardiothoracic and Vascular Anesthesia
IS - 1
ER -