Impact of epiaortic ultrasound utilization in patients undergoing coronary artery bypass grafting

Abstract

Objective

To assess whether the use of epiaortic ultrasound for assessment of aortic calcification impacts the rate of postoperative stroke following coronary artery bypass grafting (CABG).

Methods

This was a retrospective study using an institutional database of CABGs performed from 2010 to 2023. All patients undergoing isolated index CABG were included. Patients were dichotomized according to the use of epiaortic ultrasound for intraoperative aortic assessment. Postoperative stroke rates were compared, and multivariable logistic regression analysis was performed for postoperative stroke. Cox regression was performed for the multivariable analysis of mortality.

Results

A total of 10,049 patients underwent isolated index CABG. Intraoperative epiaortic ultrasound was used in 1572 (15.6%) of these patients. The Society of Thoracic Surgeons predicted risk of stroke was 1% and did not differ between the 2 study groups. Postoperative stroke occurred in 13 patients in the epiaortic ultrasound group (0.8%) versus 116 patients in the group in which epiaortic ultrasound was not used (1.4%; P = .08). On multivariable logistic regression, the use of epiaortic ultrasound was not associated with a reduced odds of postoperative stroke (odds ratio, 0.62; 95% confidence interval [CI], 0.34-1.14; P = .12). Epiaortic ultrasound use was also not significantly associated with hazards of mortality on Cox regression (hazard ratio [HR], 1.14; 95% CI, 0.94-1.38; P = .12). Postoperative stroke was significantly associated with an increased hazard of death (HR, 2.25; 95% CI, 1.61-3.14; P < .001).

Conclusions

Stroke rates after CABG were 0.8% with the use of epiaortic ultrasound and 1.4% without the use of epiaortic ultrasound. The current study did not find an independent association between epiaortic ultrasound use and postoperative stroke.