Epiaortic Ultrasound to Prevent Stroke in Coronary Artery Bypass Grafting

Abstract Background Epiaortic ultrasound (EAU) is a valid imaging method to detect atherosclerotic changes of the ascending aorta and to guide surgical strategies for prevention of cerebral embolism in patients undergoing isolated coronary artery bypass grafting (CABG). However, its use is not widespread. Methods The impact of EAU on the outcome after isolated CABG has been investigated in patients from the multicenter E-CABG registry. A systematic review and meta-analysis of the literature was performed to substantiate the findings of this observational study. Results Out of 7241 patients from the E-CABG registry, EAU was performed intraoperatively in 673 patients (9.3%). In the overall series, the rates of stroke without and with aortic manipulation were 0.3% and 1.3% (p=0.003). In 660 propensity score matched pairs, EAU was associated with significantly lower risk of stroke (0.6% vs. 2.6%, p=0.007). Literature search yielded five studies fulfilling the inclusion criteria. These studies along with the present one included 11496 patients, of whom 3026 (25.7%) underwent intraoperative EAU and their rate of postoperative stroke was significantly lower than in patients not investigated with EAU (pooled rate, 0.6% vs. 1.9%; RR 0.40, 95%CI 0.24-0.66, I2 0%). Based on these pooled rates, the number needed to treat to prevent one stroke is 76.9. Conclusions Avoiding aortic manipulation is associated with the lowest risk of stroke in patients undergoing CABG. When manipulation of the ascending aorta is planned, EAU is effective in guiding the surgical strategy to reduce the risk for embolic stroke in these patients.