Epiaortic Ultrasound to Prevent Stroke in Coronary Artery Bypass Grafting

Fausto Biancari, Francesco Santini, Tuomas Tauriainen, Ciro Bancone, Vito G. Ruggieri, Andrea Perrotti, Riccardo Gherli, Till Demal, Magnus Dalén, Giuseppe Santarpino, Antonino S. Rubino, Saverio Nardella, Francesco Nicolini, Marco Zanobini, Marisa De Feo, Francesco Onorati, Giovanni Mariscalco, Giuseppe Gatti

Research output: Contribution to journalReview articlepeer-review


Background: Epiaortic ultrasonography (EAU) is a valid imaging method to detect atherosclerotic changes of the ascending aorta and to guide surgical strategies for the 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 was investigated in patients from the European Multicenter Study on Coronary Artery Bypass Grafting (E-CABG) registry. A systematic review and meta-analysis of the literature was performed to substantiate the findings of this observational study. Results: EAU was performed intraoperatively in 673 of 7241 patients (9.3%) from the E-CABG registry. In the overall series, the rates of stroke without and with aortic manipulation were 0.3% and 1.3%, respectively (P = .003). In 660 propensity score–matched pairs, EAU was associated with significantly lower risk of stroke (0.6% vs 2.6%, P = .007). A literature search yielded 5 studies fulfilling the inclusion criteria. These studies, along with the present one, included 11,496 patients, of whom 3026 (25.7%) underwent intraoperative EAU. Their rate of postoperative stroke was significantly lower than in patients not investigated with EAU (pooled rate, 0.6% vs 1.9%; risk ratio, 0.40; 95% confidence interval, 0.24-0.66; I2 = 0%). On the basis of these pooled rates, the number needed to treat to prevent 1 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.

Original languageEnglish
Pages (from-to)294-301
Number of pages8
JournalAnnals of Thoracic Surgery
Issue number1
Publication statusPublished - Jan 2020

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine


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