| Title | Epiaortic scanning modifies planned intraoperative surgical management but not cerebral embolic load during coronary artery bypass surgery. | | Author(s) | Djaiani G, Ali M, Borger MA, Woo A, Carroll J, Feindel C, Fedorko L, Karski J, Rakowski H | | Institution | Department of Anesthesiology, Toronto General Hospital, Eaton North 3-410, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada. george.djaiani@uhn.on.ca | | Source | Anesth Analg 2008 Jun; 106(6):1611-8. | | MeSH | Aged
Aorta
Aortic Diseases
Atherosclerosis
Cardiopulmonary Bypass
Clinical Protocols
Coronary Artery Bypass
Coronary Artery Disease
Echocardiography, Transesophageal
Female
Humans
Infarction, Middle Cerebral Artery
Intraoperative Care
Male
Palpation
Patient Selection
Prospective Studies
Severity of Illness Index
Time Factors
Treatment Outcome
Ultrasonography, Doppler, Transcranial
Ultrasonography, Interventional
| | Abstract | BACKGROUND: Patients with aortic atheroma are at increased risk for neurological injury after coronary artery bypass graft (CABG) surgery. We sought to determine the role of epiaortic ultrasound scanning for reducing cerebral embolic load, and whether its use leads to changes of planned intraoperative surgical management in patients undergoing CABG surgery.
METHODS: Patients >70-yr-of-age scheduled for CABG surgery were prospectively randomized to either an epiaortic scanning (EAS) group (aortic manipulation guided by epiaortic ultrasound) or a control group (manual aortic palpation without EAS). All patients received a comprehensive transesophageal echocardiographic examination. Transcranial Doppler (TCD) was used to monitor the middle cerebral arteries for emboli continuously from 2 min before aortic cannulation to 2 min after aortic decannulation. Neurological assessment was performed with the National Institute of Health stroke scale before surgery and at hospital discharge. The NEECHAM confusion scale was used for assessment and monitoring of patient global cognitive function on each day after surgery until hospital discharge.
RESULTS: Intraoperative surgical management was changed in 16 of 55 (29%) patients in the EAS group and in 7 of 58 (12%) patients in the control group (P = 0.025). These changes included adjustments of the ascending aorta cannulation site for cardiopulmonary bypass (CPB), the avoidance of aortic cross-clamping by using ventricular fibrillatory arrest during surgery, or by conversion to off-pump surgery. During surgery, 7 of 58 (12%) patients in the control group crossed over to the EAS group based on the results of manual aortic palpation. The median [range] TCD detected cerebral embolic count did not differ between the EAS and control groups during aortic manipulations (EAS, 11.5 [1-516] vs control, 22.0 [1-160], P = 0.91) or during CPB (EAS, 42.0 [4-516] vs control, 63.0 [5-758], P = 0.46). The NEECHAM confusion scores and National Institute of Health stroke scale scores were similar between the two groups.
CONCLUSIONS: These results show that the use of EAS led to modifications in intraoperative surgical management in almost one-third of patients undergoing CABG surgery. The use of EAS did not lead to a reduced number of TCD-detected cerebral emboli before or during CPB. | | Language | eng | | Pub Type(s) | Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
| | PubMed ID | 18499587 |
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