TY - JOUR
T1 - Routine Intraoperative Transesophageal Echocardiography Identifies Patients with Atheromatous Aortas
T2 - Impact on "Off-pump" Coronary Artery Bypass and Perioperative Stroke
AU - Grossi, Eugene A.
AU - Bizekis, Costas S.
AU - Sharony, Ram
AU - Saunders, Paul C.
AU - Galloway, Aubrey C.
AU - LaPietra, Angelo
AU - Applebaum, Robert M.
AU - Esposito, Rick A.
AU - Ribakove, Greg H.
AU - Culliford, Alfred T.
AU - Kanchuger, Marc
AU - Kronzon, Itzhak
AU - Colvin, Stephen B.
N1 - Funding Information:
Supported in part by The Foundation for Research in Cardiac Surgery and Cardiovascular Biology.
PY - 2003/7
Y1 - 2003/7
N2 - Background: Patients with severe atheromatous aortic disease (AAD) undergoing coronary artery bypass grafting (CABG) have increased operative risks. The "off-pump" CABG (OPCAB) technique was evaluated in patients given the diagnosis of severe AAD by routine transesophageal echocardiography. Methods: A total of 5737 patients underwent CABG, with 913 having transesophageal echocardiography findings of severe AAD. Of the patients with severe AAD, 678 (74.3%) had conventional CABG and 235 (25.7%) had OPCAB. Results: Hospital mortality was 8.7% for conventional CABG and 5.1% for OPCAB (P = .08). Multivariate analysis revealed that increased mortality was significantly associated with acute myocardial infarction, conventional CABG, age, renal disease, history of stroke, and ejection fraction < 30%. Neurologic complications occurred in 6.3% of patients undergoing CABG and in 2.1% undergoing OPCAB (P = .01). Freedom from any complication was significantly greater with OPCAB. Conclusion: Routine intraoperative transesophageal echocardiography identifies patients with severe AAD. In these patients, OPCAB technique is associated with a lower risk of death, stroke, and all complications.
AB - Background: Patients with severe atheromatous aortic disease (AAD) undergoing coronary artery bypass grafting (CABG) have increased operative risks. The "off-pump" CABG (OPCAB) technique was evaluated in patients given the diagnosis of severe AAD by routine transesophageal echocardiography. Methods: A total of 5737 patients underwent CABG, with 913 having transesophageal echocardiography findings of severe AAD. Of the patients with severe AAD, 678 (74.3%) had conventional CABG and 235 (25.7%) had OPCAB. Results: Hospital mortality was 8.7% for conventional CABG and 5.1% for OPCAB (P = .08). Multivariate analysis revealed that increased mortality was significantly associated with acute myocardial infarction, conventional CABG, age, renal disease, history of stroke, and ejection fraction < 30%. Neurologic complications occurred in 6.3% of patients undergoing CABG and in 2.1% undergoing OPCAB (P = .01). Freedom from any complication was significantly greater with OPCAB. Conclusion: Routine intraoperative transesophageal echocardiography identifies patients with severe AAD. In these patients, OPCAB technique is associated with a lower risk of death, stroke, and all complications.
UR - http://www.scopus.com/inward/record.url?scp=0043211697&partnerID=8YFLogxK
U2 - 10.1016/S0894-7317(03)00284-0
DO - 10.1016/S0894-7317(03)00284-0
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C2 - 12835662
AN - SCOPUS:0043211697
SN - 0894-7317
VL - 16
SP - 751
EP - 755
JO - Journal of the American Society of Echocardiography
JF - Journal of the American Society of Echocardiography
IS - 7
ER -
