Reduced neuropsychological dysfunction using epiaortic echocardiography and the exclusive Y graft

Background. To examine the effect of screening the aorta for atheroma befor e aortic manipulation and use of exclusive Y graft revascularization on the incidence of neuropsychological dysfunction after coronary artery bypass. Methods. Aortic atheroma was detected using epiaortic and transesophageal e chocardiography. Atheroma avoidance was facilitated by use of the exclusive Y graft technique, which has no aortic coronary anastomoses. In the contro l group aortic atheroma was assessed by manual palpation, and we attempted to avoid any atheroma detected. In this group we also used aorta-coronary g rafts. Transcranial Doppler imaging of the right middle cerebral artery was used to detect cerebral microemboli. Neuropsychological dysfunction was de fined as a 20% or more decline in score for at least 20% of a neuropsychome tric battery of ten tests for each patient. Results. Late dysfunction at 57 +/- 2 days postoperatively in the control g roup was 38.1% and in the echo/Y group was 3.8% (p' = 0.012). Microemboli d etected by transcranial Doppler imaging during periods of aortic manipulati on was greater for those with late dysfunction (5.2 +/- 3.0 compared with 0 .5 +/- 0.2) (p' = 0.018). No clinical strokes occurred in either group. Conclusions. The combined techniques of epiaortic screening and exclusive Y graft for coronary artery bypass operations resulted in a low incidence of late neuropsychological dysfunction. (C) 2000 by The Society of Thoracic Surgeons.