TY - JOUR
T1 - Intraoperative Epi-Aortic Scans Reduce Adverse Neurological Sequelae in Elderly, High Risk Patients Undergoing Coronary Artery Bypass Surgery – a Propensity Matched, Cumulative Sum Control Analysis
AU - Luthra, Suvitesh
AU - Leiva Juarez, Miguel M.
AU - Tahir, Zaheer
AU - Yiu, Patrick
PY - 2017/7
Y1 - 2017/7
N2 - Background Adverse neurological sequelae are a major cause of morbidity and mortality after coronary artery bypass (CABG) surgery, due to manipulation of an atherosclerotic aorta. The purpose of this study is to measure the impact of intraoperative epi-aortic scanning in reducing neurologic sequelae after CABG, and the patient subgroups that are benefitted the most. Methods Patients that underwent first-time CABG from July 2010 to March 2014 (n=1,989) were retrospectively reviewed and stratified by history of intraoperative epi-aortic scan (n=350) or no scan (n=1,639). Baseline characteristics, rates of adverse neurological events, and overall survival were compared among groups in both matched and unmatched cohorts and tested using Student's t-test, chi2 test, or log-rank test, respectively. Multivariable analysis using logistic regression was performed to identify potential predictors for neurological sequelae. Cumulative summation plots (CUSUM) were constructed to display the number of preventable adverse neurological events per consecutive patient that underwent CABG. A p≤0.05 was considered statistically significant. Results The use of epi-aortic scan (OR: 0.29, 95% CI: 0.09–0.99, p=0.48) was an independent predictor of adverse events. Overall rates of stroke (0.29% vs 0.55%), postoperative confusional state (1.43% vs 3.42%), or both (1.71% vs 3.72%) were lower in those scanned. CUSUM scores were higher in scanned patients, especially in those with an age above 70 years or logistic Euroscore >2. Conclusions Intraoperative epi-aortic scan is an effective assessment tool for atherosclerotic burden in the ascending aorta and can guide surgical strategy to decrease adverse neurological outcomes, particularly in high risk and elderly patients.
AB - Background Adverse neurological sequelae are a major cause of morbidity and mortality after coronary artery bypass (CABG) surgery, due to manipulation of an atherosclerotic aorta. The purpose of this study is to measure the impact of intraoperative epi-aortic scanning in reducing neurologic sequelae after CABG, and the patient subgroups that are benefitted the most. Methods Patients that underwent first-time CABG from July 2010 to March 2014 (n=1,989) were retrospectively reviewed and stratified by history of intraoperative epi-aortic scan (n=350) or no scan (n=1,639). Baseline characteristics, rates of adverse neurological events, and overall survival were compared among groups in both matched and unmatched cohorts and tested using Student's t-test, chi2 test, or log-rank test, respectively. Multivariable analysis using logistic regression was performed to identify potential predictors for neurological sequelae. Cumulative summation plots (CUSUM) were constructed to display the number of preventable adverse neurological events per consecutive patient that underwent CABG. A p≤0.05 was considered statistically significant. Results The use of epi-aortic scan (OR: 0.29, 95% CI: 0.09–0.99, p=0.48) was an independent predictor of adverse events. Overall rates of stroke (0.29% vs 0.55%), postoperative confusional state (1.43% vs 3.42%), or both (1.71% vs 3.72%) were lower in those scanned. CUSUM scores were higher in scanned patients, especially in those with an age above 70 years or logistic Euroscore >2. Conclusions Intraoperative epi-aortic scan is an effective assessment tool for atherosclerotic burden in the ascending aorta and can guide surgical strategy to decrease adverse neurological outcomes, particularly in high risk and elderly patients.
KW - Acute confusional syndrome
KW - Coronary artery bypass surgery
KW - Epi-aortic scan
KW - Stroke
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U2 - 10.1016/j.hlc.2016.11.009
DO - 10.1016/j.hlc.2016.11.009
M3 - Article
C2 - 28126241
AN - SCOPUS:85010005223
SN - 1443-9506
VL - 26
SP - 709
EP - 716
JO - Heart Lung and Circulation
JF - Heart Lung and Circulation
IS - 7
ER -