Routine Intraoperative Transesophageal Echocardiography Identifies Patients with Atheromatous Aortas: Impact on "Off-pump" Coronary Artery Bypass and Perioperative Stroke

Eugene A. Grossi, Costas S. Bizekis, Ram Sharony, Paul C. Saunders, Aubrey C. Galloway, Angelo LaPietra, Robert M. Applebaum, Rick A. Esposito, Greg H. Ribakove, Alfred T. Culliford, Marc Kanchuger, Itzhak Kronzon, Stephen B. Colvin

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)751-755
Number of pages5
JournalJournal of the American Society of Echocardiography
Volume16
Issue number7
DOIs
StatePublished - Jul 2003

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