Prevention of cerebrovascular complications in coronary artery bypass grafting

Myalyuk P.A.¹, Marchenko A.V.¹, Arutyunyan V.B.¹, Chragyan V.A.¹, Alekseevich G.Yu.², Vronskiy A.S.³

1) Federal Centre for Cardiovascular Surgery named after G.S. Sukhanov under the Ministry of Public Health of the Russian Federation, Perm,
2) Krasnoyarsk State Medical University named after Professor V.F. Voino-Yasenetsky under the Ministry of Public Health of the Russian Federation, Krasnoyarsk,
3) Perm State Medical University named after Academician E.A. Wagner under Ministry of Public Health of the Russian Federation, Perm, Russia

The authors carried out a comparative analysis of the incidence rate of cerebrovascular complications following coronary artery bypass grafting performed using either a differentiated approach to surgical policy depending on the findings of epiaortic ultrasonographic scanning or the standard conventional approach.

A total of 3,454 operations of coronary artery bypass grafting were performed. All patients were divided into two groups. Patients of the Study Group (n=765) were subjected to obligatory intraoperative epiaortic scanning, with the variant of further surgical intervention depending on the obtained findings of the examination. The Control Group patients (n=2,689) underwent standard coronary artery bypass grafting in the conditions of artificial circulation (AC).

In the Study Group patients, depending on the degree and localization of the atherosclerotic lesion of the aorta, determined by the findings of epiaortic scanning, one of the following techniques of coronary artery bypass grafting (CABG) was chosen: cases with no lesion were managed by CABG with AC (585 patients); a local solitary lesion was managed by altering the site of cannulation and application of the clamp (92 patients) or by the operation according to the "single clamp" technique (43 patients); cases of manifested atherosclerosis of the ascending aorta were treated by the "on-pump beating-heart" technique in the conditions of AC without placing clamps (27 patients); cases of massive involvement of the ascending aorta and aortic arch were managed by CABG performed according to the “no-touch aorta” technique (18 patients).

The total mortality rate amounted to 1.1%. Thirty-three (0.96%) patients in the postoperative period were found to have ischaemic stroke. The mortality rate in the Control Group amounted to 1.4% and that in the Study Group equalled 0.3%, with the number of cases of ischaemic strokes amounting to 33 (1.4%) and 0, respectively. Perioperative infarction was diagnosed in 16 (0.6%) cases in the Control Group and in 5 (0.7%) patients in the group treated using the differentiated approach.

A conclusion was drawn that the differentiated approach to choosing the technique of CABG based on the findings obtained by means of epiaortic scanning was associated with a statistically significant decrease in both the number of ischaemic strokes and the mortality rate after CABG operations.

KEY WORDS: coronary artery bypass grafting, epiaortic ultrasonographic scanning, aortic atheromatosis, stroke.

P. 156

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