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Ann Thorac Surg 2001;71:398
© 2001 The Society of Thoracic Surgeons

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Correspondence

Epiaortic ultrasound, Y graft, and postoperative neuropsychological dysfunction: Reply

^a Departments of Cardiothoracic Surgery and Anesthesia, Private Medical Centre, PO Box 2135, The Royal Melbourne Hospital, Parkville, Victoria 3052, Australia

e-mail: alistair.royse{at}mh.org.au

To the Editor

We thank Dr Olsson for supporting our findings [1]. Epiaortic echocardiography accurately identifies aortic atheroma. Avoidance of the atheroma is facilitated by the Y graft technique, where there are no aortic anastomoses. This may reduce brain dysfunction consequent on reduced cerebral atheroembolism.

Since each group reflected the routine operative techniques of different surgeons, no randomization was possible. There were no preoperative differences and minor perioperative differences. Anesthetic differences would affect patients in the short term. The value of the control group is to allow comparison with other studies. Dysfunction in this group equated to the low to mid range of dysfunction reported in the literature.

It is recognized that there are a number of potentially confounding factors; however, it is considered that these could have been more controlled or even removed in this study. No perioperative analgesics or other management such as ventilation should influence the results of the late assessment. It is known that neuropsychological dysfunction diminishes with time postoperatively, but a difference of 2 weeks is highly unlikely to explain the full magnitude of the difference between the groups. The absolute difference in dysfunction was 34.3% and represents a relative reduction of 90%.

Activities of daily living or psychological well-being were not investigated, being beyond the scope of this study.

We advocate routine epiaortic echocardiography for all adult cardiac surgery patients. For patients undergoing coronary surgery using cardiopulmonary bypass, the Y graft technique will facilitate greater alteration of the sites of aortic manipulation in order to avoid aortic atheroma than a technique that involves aorta-coronary anastomoses. For patients undergoing off-pump (or beating heart) coronary surgery, the Y graft technique offers complete revascularization with complete avoidance of aortic manipulation.

References

1. Royse A.G., Royse C.F., Ajani A.E., et al. Reduced neuropsychological dysfunction using epiaortic echocardiography and the exclusive Y graft. Ann Thorac Surg 2000;69:1431-1438.

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Alistair G. Royse Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Royse, A. G. Articles by Royse, C. F. Search for Related Content PubMed PubMed Citation Articles by Royse, A. G. Articles by Royse, C. F. Related Collections Cerebral protection Coronary disease