HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:
Guest Access | Sign In via User Name/Password

This Article Full Text Free Full Text (PDF) Free Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (7) Citing Articles via Google Scholar Google Scholar Articles by Bolotin, G. Articles by Uretzky, G. Search for Related Content PubMed PubMed Citation Articles by Bolotin, G. Articles by Uretzky, G.

Use of Intraoperative Epiaortic Ultrasonography To Delineate Aortic Atheroma^*

^* From the Department of Cardiothoracic Surgery (Drs. Bolotin, de Perini, Frolkis, Lev-Ran, Nesher, and Uretzky), Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; and The Bruce Rappaport School of Medicine (Mr. Domany), the Technion, Haifa, Israel.

Correspondence to: Gil Bolotin, MD, PhD, The Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center, 6 Weizman St, Tel-Aviv, 64239, Israel; e-mail: bolotin{at}tasmc.health.gov.il

Objective: A cerebrovascular accident (CVA) is a devastating complication of coronary artery bypass grafting (CABG) and a major cause for morbidity and mortality. Aortic manipulation, cannulation, and clamping during CABG may lead to release of atheromatous material from the ascending aorta, which may cause a CVA. This study assessed the hypothesis that the use of intraoperative epiaortic ultrasonography (EAUS) would supplement imaging information with that derived from manual aortic palpation and influence the surgical decision-making approach accordingly.

Methods: After undergoing a mid-sternotomy for CABG, 105 patients underwent EAUS with an 8-MHz transducer ordinarily used for conventional transthoracic echocardiography. The surgical strategy was decided on at three stages: preoperatively, after manual aortic palpation, and following EAUS.

Results: The preoperative strategy had assigned 105 patients to the "touched aorta" group that was planned for either on-pump or off-pump CABG (OPCAB) with proximal anastomosis to the aorta. Pathologic lesions of the atheromatotic ascending aorta were evident in 40 patients (38%), with the lesions detected in 22 patients (21%) by both palpation and EAUS, and in 18 patients (17%) by EAUS alone. The planned surgical strategy was changed in 29 patients (28%): 25 patients (24%) were converted from on-pump CABG to OPCAB, and the EAUS influenced the choice of the aortic cannulation, cross-clamping, and proximal anastomosis site in 4 patients (4%). Among the changes in surgical decision making, changes in 11 patients (10%) were based on lesion detection by both manual palpation and EAUS; in 18 patients (17%), changes resulted from pathologic evidence provided by EAUS alone.

Conclusions: This study showed EAUS to be more sensitive in detecting atherosclerotic lesions than manual intraoperative palpation of the ascending aorta. This investigation contributes new data on the effect of EAUS on intraoperative surgical approach in the era of OPCAB. The use of EAUS has emerged as an important tool in intraoperative decision making, and we recommend its use routinely in CABG procedures.

Key Words: cerebrovascular accident • coronary artery bypass • epiaortic ultrasound

This article has been cited by other articles:

				D. Jegger, P.-G. Chassot, M.-A. Bernath, J. Horisberger, P. Gersbach, P. Tozzi, D. Delay, and L. K. von Segesser A novel technique using echocardiography to evaluate venous cannula performance perioperatively in CPB cardiac surgery. Eur. J. Cardiothorac. Surg., April 1, 2006; 29(4): 525 - 529. [Abstract] [Full Text] [PDF]