ArticleClinical cardiology2022
The brain-before-heart strategy for coronary artery bypass grafting in the severely atherosclerotic aorta: A single-institution experience.
Article in Clinical cardiology, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed, 2 citations in OpenAlex.
- Multivessel Coronary Disease and Severe Atherosclerotic Aorta: Real-World Experience.Medicina (Kaunas, Lithuania) · 2023Observational
- The brain-before-heart strategy for coronary artery bypass grafting in the severely atherosclerotic aorta: A single-institution experience.Clinical cardiology · 2022Article
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2 authors at 2 institutions in 1 country.
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Abstract
backgroundSevere atherosclerosis of the ascending aorta (SAA) in patients undergoing surgical revascularization by coronary artery bypass grafting (CABG) is becoming an increasing problem as more elderly patients are diagnosed with coronary artery disease. Strokes and other neurologic insults are common complications in this group, with devastating impacts on outcomes and prognoses. HYPOTHESIS: Early detection of the atherosclerotic aorta and the application of a stroke prevention protocol will reduce the risk of stroke in patients with SAA.
methodsIn 2012, we adopted a protocol devised to preemptively detect and manage patients suspected of having SAA. From the time of the application of the protocol, we compared the immediate and late outcomes of CABG in SAA in the 8 years preceding the protocol in a "control" group (30 patients) and in the 8 years following the protocol in a "brain" group (69 patients).
resultsMore patients with SAA were detected after the initiation of the protocol. They had significantly more history of stroke, renal dysfunction, and left main coronary disease. The percutaneous coronary intervention was utilized more after the protocol (26% vs. 7%) and there was far less utilization of replacement of the ascending aorta (12% vs. 37%). Postoperative stroke rates were significantly less after the protocol (2% vs. 18%), with an almost twofold reduction in stroke associated with SAA even after risk adjustment. The composite endpoints of cardiac death, nonfatal myocardial infarction, and stroke were significantly reduced after initiating the protocol at a median of 2.3 years from the time of revascularization.
conclusionEarly detection of SAA and individualized therapeutic strategies for revascularization is effective in reducing athero-embolic brain injury and are associated with better prognosis.
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