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The Annals of Thoracic Surgery, Vol 55, 1400-1407, Copyright © 1993 by The Society of Thoracic Surgeons
TH Wareing, VG Davila-Roman, BB Daily, SF Murphy, KB Schechtman, B Barzilai and NT Kouchoukos
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 > or = 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.
ARTICLES
Strategy for the reduction of stroke incidence in cardiac surgical patients
Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri.
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C. W. Hogue Jr, S. F. Murphy, K. B. Schechtman, and V. G. Davila-Roman Risk Factors for Early or Delayed Stroke After Cardiac Surgery Circulation, August 10, 1999; 100(6): 642 - 647. [Abstract] [Full Text] [PDF]
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M. Gaudino, F. Glieca, F. Alessandrini, C. Cellini, N. Luciani, C. Pragliola, R. Schiavello, and G. Possati Individualized surgical strategy for the reduction of stroke risk in patients undergoing coronary artery bypass grafting Ann. Thorac. Surg., May 1, 1999; 67(5): 1246 - 1253. [Abstract] [Full Text] [PDF]
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V. G. Davila-Roman, S. F. Murphy, N. J. Nickerson, N. T. Kouchoukos, K. B. Schechtman, and B. Barzilai Atherosclerosis of the ascending aorta is an independent predictor of long-term neurologic events and mortality J. Am. Coll. Cardiol., April 1, 1999; 33(5): 1308 - 1316. [Abstract] [Full Text] [PDF]
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C. W. Hogue JR, B. Barzilai, and V. G. Davila-Roman Stroke Reduction: Diagnosis and Management of the Atherosclerotic Ascending Aorta During Cardiac Surgery Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 1999; 3(1): 17 - 24. [Abstract] [PDF]
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P. R. Vogt, M. Hauser, U. Schwarz, R. Jenni, M. L. Lachat, G. Zund, R. W. Schupbach, D. Schmidlin, and M. I. Turina Complete thromboendarterectomy of the calcified ascending aorta and aortic arch Ann. Thorac. Surg., February 1, 1999; 67(2): 457 - 461. [Abstract] [Full Text] [PDF]
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M. Ura, R. Sakata, Y. Nakayama, T.-A. Miyamoto, and T. Goto Extracorporeal circulation before and after ultrasonographic evaluation of the ascending aorta Ann. Thorac. Surg., February 1, 1999; 67(2): 478 - 483. [Abstract] [Full Text] [PDF]
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V. G. Davila-Roman, N. T. Kouchoukos, K. B. Schechtman, and B. Barzilai ATHEROSCLEROSIS OF THE ASCENDING AORTA IS A PREDICTOR OF RENAL DYSFUNCTION AFTER CARDIAC OPERATIONS J. Thorac. Cardiovasc. Surg., January 1, 1999; 117(1): 111 - 116. [Abstract] [Full Text] [PDF]
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Y. Moriyam, R. Tod, K. Hisatom, and A. Tair Axillary artery-coronary artery bypass grafting in patients with atherosclerotic ascending aorta J. Thorac. Cardiovasc. Surg., October 1, 1998; 116(4): 669 - 670. [Full Text]
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J. Bonatti, H. Hangler, H. Antretter, and L. C. Muller Axillocoronary bypass for severely atherosclerotic aorta in coronary artery bypass grafting J. Thorac. Cardiovasc. Surg., April 1, 1998; 115(4): 956 - 957. [Full Text] [PDF]
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L. L. Mickleborough, P. M. Walker, Y. Takagi, M. Ohashi, J. Ivanov, and M. Tamariz RISK FACTORS FOR STROKE IN PATIENTS UNDERGOING CORONARY ARTERY BYPASS GRAFTING J. Thorac. Cardiovasc. Surg., November 1, 1996; 112(5): 1250 - 1259. [Abstract] [Full Text]
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G. D. Buckberg Update on Current Techniques of Myocardial Protection Ann. Thorac. Surg., September 1, 1995; 60(3): 805 - 814. [Abstract] [Full Text]
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S. A. Mills Risk Factors for Cerebral Injury and Cardiac Surgery Ann. Thorac. Surg., May 1, 1995; 59(5): 1296 - 1299. [Abstract] [Full Text]
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A. J. Bryan, B. Barzilai, and N. T. Kouchoukos Transesophageal Echocardiography and Adult Cardiac Operations Ann. Thorac. Surg., March 1, 1995; 59(3): 773 - 779. [Abstract] [Full Text]
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R. E. Clark, J. Brillman, D. A. Davis, M. R. Lovell, T. R. P. Price, and G. J. Magovern MD Microemboli during coronary artery bypass grafting: Genesis and effect on outcome J. Thorac. Cardiovasc. Surg., February 1, 1995; 109(2): 249 - 258. [Abstract] [Full Text]
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A. K. Singh, A. A. Bert, W. C. Feng, and F. A. Rotenberg Stroke During Coronary Artery Bypass Grafting Using Hypothermic Versus Normothermic Perfusion Ann. Thorac. Surg., January 1, 1995; 59(1): 84 - 89. [Abstract] [Full Text]
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