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Atheromatous disease of the aorta and perioperative stroke

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Presentation on theme: "Atheromatous disease of the aorta and perioperative stroke"— Presentation transcript:

1 Atheromatous disease of the aorta and perioperative stroke
Nicholas D. Andersen, MD, Stephen A. Hart, MD, Ganesh P. Devendra, MD, Esther S.H. Kim, MD, MPH, Douglas R. Johnston, MD, Jacob N. Schroder, MD, Richard A. Krasuski, MD  The Journal of Thoracic and Cardiovascular Surgery  Volume 155, Issue 2, Pages (February 2018) DOI: /j.jtcvs Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

2 Figure 1 As blood velocity decreases near the wall of the aorta, LDL deposition increases. V, Velocity; LDL, low-density lipoprotein. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

3 Figure 2 Intraoperative transesophageal echocardiographic images from a patient with a complex aortic atheroma (oval). These 3 time-lag short-axis images of the transverse aortic arch demonstrate the mobile nature of a portion of the lesion (arrow). The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

4 Figure 3 Contrast-enhanced helical computed tomography of the chest in a patient awaiting cardiothoracic surgery. This image demonstrates significant atheromatous plaque in the aortic arch, both with (solid arrow) and without (dashed arrow) calcification. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

5 Figure 4 Commercially available embolic protection devices. A, The Embol-X intra-aortic filtration system (Edwards Lifesciences). B, The CardioGard Embolic Protection cannula (CardioGard Medical). The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

6 Can we reduce the risk of perioperative stroke from aortic atheroma?
The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

7 Video 1 Case 1: short-axis view (best viewed on repeat with Windows Media Player). Intraoperative epiaortic ultrasound scanning demonstrating normal ascending aorta before aortic cannulation in a 60-year-old woman undergoing coronary artery bypass grafting. Video available at: The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

8 Video 2 Case 1: long-axis view (best viewed on repeat with Windows Media Player). Video available at: The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

9 Video 3 Case 2: short-axis view (best viewed on repeat with Windows Media Player). Epiaortic ultrasound scanning identified a large shelf of calcified posterior plaque in the distal ascending aorta/proximal arch in a 77-year-old woman undergoing coronary artery bypass grafting and aortic valve replacement. Ultrasound was used to identify and select sites for aortic cannulation, crossclamping, aortotomy, and proximal anastomoses in areas of unaffected ascending aorta well away from the posterior shelf. Video available at: The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

10 Video 4 Case 2: long-axis view (best viewed on repeat with Windows Media Player). Video available at: The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

11 Video 5 Case 3: short-axis view (best viewed on repeat with Windows Media Player). Epiaortic ultrasound scanning demonstrated diffuse calcifications in the anterior and posterior ascending aorta in a 75-year-old man undergoing CABG. The surgical plan was altered to avoid aortic cannulation or crossclamping. The patient underwent on-pump beating-heart CABG via right axillary artery cannulation. The left internal mammary artery was grafted to the left anterior descending artery, and a saphenous vein was sequenced to the obtuse marginal and posterior descending artery distal targets, allowing for a single, proximal, aortic anastomosis performed with a clampless facilitating device. Video available at: The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

12 Video 6 Case 3: long-axis view (best viewed on repeat with Windows Media Player). Video available at: The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

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