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Epiaortic Ultrasound to Prevent Stroke in Coronary Artery Bypass Grafting.
Biancari, Fausto; Santini, Francesco; Tauriainen, Tuomas; Bancone, Ciro; Ruggieri, Vito G; Perrotti, Andrea; Gherli, Riccardo; Demal, Till; Dalén, Magnus; Santarpino, Giuseppe; Rubino, Antonino S; Nardella, Saverio; Nicolini, Francesco; Zanobini, Marco; De Feo, Marisa; Onorati, Francesco; Mariscalco, Giovanni; Gatti, Giuseppe.
Afiliación
  • Biancari F; Heart Center, Turku University Hospital and Department of Surgery, University of Turku, Turku, Finland; Department of Surgery, University of Oulu, Oulu, Finland. Electronic address: faustobiancari@yahoo.it.
  • Santini F; Division of Cardiac Surgery, University of Genoa, Genoa, Italy.
  • Tauriainen T; Department of Surgery, University of Oulu, Oulu, Finland.
  • Bancone C; Department of Cardiothoracic Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy.
  • Ruggieri VG; Division of Cardiothoracic and Vascular Surgery, Robert Debré University Hospital, Reims, France.
  • Perrotti A; Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz, Besançon, France.
  • Gherli R; Cardiac Surgery Unit, Department of Cardiovascular Sciences, S. Camillo-Forlanini Hospital, Rome, Italy.
  • Demal T; Hamburg University Heart Center, Hamburg, Germany.
  • Dalén M; Department of Molecular Medicine and Surgery and Department of Cardiac Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm; Sweden.
  • Santarpino G; Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany; Città di Lecce Hospital, GVM Care & Research, Lecce, Italy.
  • Rubino AS; Department of Cardiothoracic Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy.
  • Nardella S; Department of Cardiac Surgery, St Anna Hospital, Catanzaro, Italy.
  • Nicolini F; Division of Cardiac Surgery, University of Parma, Parma, Italy.
  • Zanobini M; Department of Cardiac Surgery, Centro Cardiologico-Fondazione Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy.
  • De Feo M; Division of Cardiothoracic and Vascular Surgery, Robert Debré University Hospital, Reims, France.
  • Onorati F; Division of Cardiovascular Surgery, Verona University Hospital, Verona, Italy.
  • Mariscalco G; Department of Cardiovascular Sciences, Clinical Sciences Wing, Glenfield Hospital, University of Leicester, Leicester, United Kingdom.
  • Gatti G; Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy.
Ann Thorac Surg ; 109(1): 294-301, 2020 01.
Article en En | MEDLINE | ID: mdl-31421104
BACKGROUND: Epiaortic ultrasonography (EAU) is a valid imaging method to detect atherosclerotic changes of the ascending aorta and to guide surgical strategies for the prevention of cerebral embolism in patients undergoing isolated coronary artery bypass grafting (CABG). However, its use is not widespread. METHODS: The impact of EAU on the outcome after isolated CABG was investigated in patients from the European Multicenter Study on Coronary Artery Bypass Grafting (E-CABG) registry. A systematic review and meta-analysis of the literature was performed to substantiate the findings of this observational study. RESULTS: EAU was performed intraoperatively in 673 of 7241 patients (9.3%) from the E-CABG registry. In the overall series, the rates of stroke without and with aortic manipulation were 0.3% and 1.3%, respectively (P = .003). In 660 propensity score-matched pairs, EAU was associated with significantly lower risk of stroke (0.6% vs 2.6%, P = .007). A literature search yielded 5 studies fulfilling the inclusion criteria. These studies, along with the present one, included 11,496 patients, of whom 3026 (25.7%) underwent intraoperative EAU. Their rate of postoperative stroke was significantly lower than in patients not investigated with EAU (pooled rate, 0.6% vs 1.9%; risk ratio, 0.40; 95% confidence interval, 0.24-0.66; I2 = 0%). On the basis of these pooled rates, the number needed to treat to prevent 1 stroke is 76.9. CONCLUSIONS: Avoiding aortic manipulation is associated with the lowest risk of stroke in patients undergoing CABG. When manipulation of the ascending aorta is planned, EAU is effective in guiding the surgical strategy to reduce the risk for embolic stroke in these patients.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Puente de Arteria Coronaria / Ultrasonografía Intervencional / Accidente Cerebrovascular / Complicaciones Intraoperatorias Tipo de estudio: Clinical_trials / Observational_studies / Systematic_reviews Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Ann Thorac Surg Año: 2020 Tipo del documento: Article Pais de publicación: Países Bajos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Puente de Arteria Coronaria / Ultrasonografía Intervencional / Accidente Cerebrovascular / Complicaciones Intraoperatorias Tipo de estudio: Clinical_trials / Observational_studies / Systematic_reviews Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Ann Thorac Surg Año: 2020 Tipo del documento: Article Pais de publicación: Países Bajos