Ultrasonographic demonstration of manipulation-related aortic injuries after cardiac surgery

OBJECTIVES This study was performed to evaluate the frequency and risk fact ors associated with new aortal lesions induced by surgical manipulation and their correlation with postoperative stroke. BACKGROUND Little is known about the causative mechanism of intraoperative atheroembolism after cardiac surgery. METHODS Epiaortic echocardiography was performed before cannulation and aft er decannulation in 472 patients undergoing cardiac surgery with extracorpo real circulation. RESULTS A new lesion in the ascending aortal intima was identified in 16 pa tients (3.4%) after decannulation. New lesions were severe, with mobile les ions or disruption of the intima in 10 patients. Six of the severe lesions were related to aortic clamping and the other four to aortic cannulation. T hree patients in this group had postoperative stroke. Univariate analysis i dentified only the maximal thickness of the atheroma near the aorta manipul ation site as a predictor of new lesions. The incidence of new lesions was 11.8% if the atheroma was similar to 3 to 4 mm thick and as high as 33.3% i f the atheroma was >4 mm, but only 0.8% when it was <3 mm. Total 10 patient s (2.1%) sustained neurological complications. Arteriosclerosis obliterans, atherosclerosis of the aorta and new mobile lesions were identified as pre dictors of strokes. CONCLUSIONS This study demonstrated an association between new lesions crea ted by surgical maneuvers and postoperative stroke. Embolic strokes were mo re likely to occur if new lesions were complicated with intimal disruption, especially of the mobile type. Modifications in surgical procedures will b e needed if thick plaque (especially >4 mm) is noted near the manipulation site. (J Am Coil Cardiol 2000;35:1303-10) (C) 2000 by the American College of Cardiology.