Epiaortic ultrasound: Aortic screening in coronary revascularization

Two hundred and fourteen consecutive patients (174 males and 40 females; mean age, 61 years) undergoing coronary artery bypass grafting were screened by intraoperative epiaortic B-mode ultrasonography. The operative strategy was modified under ultrasonographic guidance in 26 patients to reduce the risk of stroke. Aortic cannulation, clamping, and vein graft attachment sites were changed in 15 patients (7%), the operation was performed on a beating heart in 7 (3.3%), cardiopulmonary bypass was established via femoral cannulation and coronary artery bypass grafting was performed on a fibrillating heart in 4 (1.9%). The incidence of stroke in our coronary artery bypass patients decreased from 2.8% to 0.9%. Sensitivity of detection of ascending aortic atherosclerosis was calculated as 35.48% for palpation and 96.8% for epiaortic ultrasonography. Risk factors for significant ascending aortic atherosclerosis were age over 70 years (p = 0.004), hypertension (p = 0.03), and associated peripheral arterial disease (p = 0.02). The most frequently affected segments were the anterior (41%) and upper left (32%) aspects of the aorta. Intraoperative epiaortic B-mode ultrasonography was found to be a reliable method of detecting ascending aortic atherosclerosis, allowing the surgeon to determine operative strategy to reduce the risk of perioperative stroke.