Predictors of Diseased Ascending Aorta in Patients Undergoing Off-Pump Coronary Artery Bypass Surgery

Authors

  • Fausto Biancari
  • Jouni Heikkinen
  • Martti Mosorin
  • Elsi Rasinaho
  • Jarmo Lahtinen
  • Eija Niemelä
  • Martti Lepojärvi
  • Tatu Juvonen

DOI:

https://doi.org/10.1532/HSF98.20061087

Abstract

Objective. To identify the preoperative risk factors associated with increased prevalence of atherosclerotic lesions of the ascending aorta among patients undergoing off-pump coronary artery bypass surgery (OPCAB).

Material and Methods. OPCAB was performed in 241 patients who were intraoperatively investigated by epiaortic ultrasound for the presence of atherosclerotic lesions of the ascending aorta. The Northern New England Cardiovascular Disease Study Group (NNECVDSG) and the Multicenter Study of Perioperative Ischemia (McSPI) stroke risk scores were retrospectively calculated.

Results. A diseased ascending aorta was detected by intraoperative epiaortic ultrasound in 74 patients (30.7%). Patient's age (P = .002, odds ratio [OR] 1.067, 95% confidence interval [CI] 1.025-1.110), diabetes (P = .023; OR, 2.211; 95% CI, 1.117-4.378), extracardiac arteriopathy (P = .014; OR, 2.567; 95% CI, 1.214-5.428) and urgent/emergency operation (P < .0001; OR, 3.066; 95% CI, 1.685-5.580) were independent preoperative predictors of a diseased ascending aorta. The area under the ROC curve of the NNECVDSG score in predicting a diseased ascending aorta was 0.710 (95% CI, 0.642-0.778), and that of the McSPI score was 0.722 (95% CI, 0.655-0.788). The prevalence of a diseased ascending aorta was 11.2%, 34.7%, and 49.4% among the NNECVDSG score tertiles (P < .0001), and 11.3%, 31.7%, and 49.4% among the McSPI score tertiles (P < .0001).

Conclusions. These findings confirm the reported high incidence of a diseased ascending aorta in patients undergoing coronary artery bypass surgery. Current stroke risk scores, particularly the simple NNECVDSG score, are valuable predictors of increased prevalence of a diseased ascending aorta.

References

Calafiore AM, Di Mauro M, Teodori G, et al. 2002. Impact of aortic manipulation on incidence of cerebrovascular accidents after surgical myocardial revascularization. Ann Thorac Surg 73:1387-93.nCharlesworth DC, Likosky DS, Marrin CAS, et al, The Northern New England Cardiovascular Disease Study Group. 2003. Development and validation of a prediction model for stroke after coronary artery bypass surgery. Ann Thorac Surg 76:436-43.nCheng DC, Bainbridge D, Martin JET, Novick RJ, The Evidence-Based Perioperative Clinical Outcomes Research Group. 2005. Does off-pump coronary artery bypass reduce mortality, morbidity and resource utilization when compared with conventional coronary artery bypass? A metaanalysis of randomized trials. Anesthesiology 102:188-203.nKangasniemi OP, Luukkonen J, Biancari F, et al. 2006. Risk scoring methods for prediction of postoperative stroke after coronary artery bypass surgery. J Thorac Cardiovasc Surg 131:734-5.nKapetanakis EI, Stamou SC, Dullum MKC, et al. 2004. The impact of aortic manipulation on neurologic outcomes after coronary artery bypass surgery: a risk-adjusted study. Ann Thorac Surg 78:1564-71.nNewman MF, Wolman R, Kanchurger M, et al, and participants in the Multicenter Study of Perioperative Ischemia (McSPI) Research Group. 1996. Multicenter preoperative stroke risk index for patients undergoing coronary artery bypass graft surgery. Circulation 94(suppl II):II74-80.nWijeysundera DN, Beattie S, Djaiani G, et al. 2005. Off-pump coronary artery surgery for reducing mortality and morbidity. Meta-analysis of randomized and observational studies. J Am Coll Cardiol 46:872-82.n

Published

2006-10-09

How to Cite

Biancari, F., Heikkinen, J., Mosorin, M., Rasinaho, E., Lahtinen, J., Niemelä, E., Lepojärvi, M., & Juvonen, T. (2006). Predictors of Diseased Ascending Aorta in Patients Undergoing Off-Pump Coronary Artery Bypass Surgery. The Heart Surgery Forum, 9(6), E857-E860. https://doi.org/10.1532/HSF98.20061087

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