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Intraoperative epiaortic scanning for preventing early stroke after off-pump coronary artery bypass

Authors
 H.-C. Joo  ;  Y.-N. Youn  ;  Y.-L. Kwak  ;  G.-J. Yi  ;  K.-J. Yoo 
Citation
 BRITISH JOURNAL OF ANAESTHESIA, Vol.111(3) : 374-381, 2013 
Journal Title
BRITISH JOURNAL OF ANAESTHESIA
ISSN
 0007-0912 
Issue Date
2013
MeSH
Adult ; Aged ; Aged, 80 and over ; Aorta/diagnostic imaging* ; Cohort Studies ; Constriction ; Coronary Artery Bypass, Off-Pump/methods* ; Echocardiography, Transesophageal/methods ; Female ; Humans ; Incidence ; Korea/epidemiology ; Male ; Middle Aged ; Monitoring, Intraoperative/methods* ; Reproducibility of Results ; Retrospective Studies ; Stroke/epidemiology ; Stroke/prevention & control*
Keywords
coronary artery bypass ; early stroke ; echocardiography ; epiaortic scanning ; monitoring ; stroke
Abstract
BACKGROUND:
Numerous studies have demonstrated the accuracy of epiaortic ultrasound scanning (EAS) for assessing ascending aortic disease. It remains unclear whether EAS changes the incidence of perioperative stroke after off-pump coronary artery bypass (OPCAB).
METHODS:
We studied a retrospective cohort of 2292 patients who underwent isolated OPCAB from January 2001 to December 2011. Patients were retrospectively subdivided into two groups: the non-EAS group (n=1019) who underwent OPCAB under only intraoperative transoesophageal echocardiography and the EAS group (n=1273) who underwent OPCAB under EAS.
RESULTS:
In the non-EAS group, 317 (31.1%) patients underwent OPCAB with partial aortic clamping and 702 (68.9%) underwent OPCAB without partial aorta clamping. In the EAS group, 301 (23.7%) patients underwent OPCAB with partial aortic clamping and 972 (76.3%) underwent OPCAB without partial aortic clamping. The incidence of early stroke was not different statistically between the EAS and non-EAS groups [non-EAS 1.7% (17/1019) vs EAS 0.8% (10/1273); P=0.052]. However, in the subgroups of patients with partial aorta clamping, the incidence of the early stroke was significantly lower in the EAS group [2.8% (9/317) vs 0.7% (2/301) P=0.041].
CONCLUSIONS:
EAS has a significant clinical benefit in reducing the incidence of early stroke in cases of partial aortic clamping in OPCAB. Therefore, EAS should be considered in patients who need partial aortic clamping in OPCAB.
Full Text
http://bja.oxfordjournals.org/content/111/3/374.long
DOI
10.1093/bja/aet113
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
Yonsei Authors
Kwak, Young Lan(곽영란) ORCID logo https://orcid.org/0000-0002-2984-9927
Yoo, Kyung Jong(유경종) ORCID logo https://orcid.org/0000-0002-9858-140X
Youn, Young Nam(윤영남)
Yi, Gi Jong(이기종)
Joo, Hyun Chel(주현철) ORCID logo https://orcid.org/0000-0002-6842-2942
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/87935
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