Stroke reduction: Diagnosis and management of the atheroclerotic ascending aorta during cardiac surgery

C. W. Hogue, B. Barzilai, V. G. Davila-Roman

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)17-24
Number of pages8
JournalSeminars in Cardiothoracic and Vascular Anesthesia
Volume3
Issue number1
DOIs
StatePublished - Jan 1 1999

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Anesthesiology and Pain Medicine

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