SEVERITY OF AORTIC ATHEROMATOUS DISEASE DIAGNOSED BY TRANSESOPHAGEAL ECHOCARDIOGRAPHY PREDICTS STROKE AND OTHER OUTCOMES ASSOCIATED WITH CORONARY-ARTERY SURGERY - A PROSPECTIVE-STUDY

Advanced atheromatous disease of the thoracic aorta identified by tran sesophageal echocardiography (TEE) is a major risk factor for perioper ative stroke. This study investigated whether varying degrees of ather osclerosis of the descending aorta, as assessed by TEE, are an indepen dent predictor of cardiac and neurologic outcome in patients undergoin g coronary artery bypass grafting (CABG). Intraoperative TEE of the de scending aorta was performed on 189 of 248 patients participating in a randomized controlled trial of low (50-60 mm Hg) or high (80-100 mm H g) mean arterial pressure during cardiopulmonary bypass for elective C ABG. Aortic atheromatous disease was graded from I to V in order of in creasing severity by observers blinded to outcome. Measured outcomes w ere death, stroke, and major cardiac events assessed at 1 wk and 6 mo. Nine of the 189 patients with TEE examinations had perioperative stro kes by 1 wk. At 1 wk, no strokes had occurred in the 123 patients with atheroma Grades I or II, while the l-wk stroke rate was 5.5% (2/36), 10.5% (2/19), and 45.5% (5/11) for Grades III, IV, and V, respectively (Fisher's exact test, P = 0.00001). For 6-mo outcome, advancing aorti c atheroma grade was a univariate predictor of stroke (P = 0.00001) an d death (P = 0.03). By 6 mo there were one additional stroke, three ad ditional deaths, and one additional major cardiac event. Atheromatous disease of the descending aorta was a strong predictor of stroke and d eath after CABG. TEE determination of atheroma grade is a critical ele ment in the management of patients undergoing CABG surgery.