Advanced atheromatous disease of the thoracic aorta identified by transesophageal echocardiography (TEE) is a major risk factor for perioperative
stroke. This study investigated whether varying degrees of
atherosclerosis of the descending aorta, as assessed by TEE, are an independent predictor of cardiac and neurologic outcome in patients undergoing
coronary artery bypass grafting (CABG). Intraoperative TEE of the descending aorta was performed on 189 of 248 patients participating in a randomized controlled trial of low (50-60 mm Hg) or high (80-100 mm Hg) mean arterial pressure during
cardiopulmonary bypass for elective CABG. Aortic atheromatous disease was graded from I to V in order of increasing severity by observers blinded to outcome. Measured outcomes were death,
stroke, and major
cardiac events assessed at 1 wk and 6 mo. Nine of the 189 patients with TEE examinations had perioperative
strokes by 1 wk. At 1 wk, no
strokes had occurred in the 123 patients with
atheroma Grades I or II, while the 1-wk
stroke rate was 5.5% (2/36), 10.5% (2/19), and 45.5% (5/11) for Grades III, IV, and V, respectively (Fisher's exact test, P = 0.00001). For 6-mo outcome, advancing aortic
atheroma grade was a univariate predictor of
stroke (P = 0.00001) and death (P = 0.03). By 6 mo there were one additional
stroke, three additional deaths, and one additional major
cardiac event. Atheromatous disease of the descending aorta was a strong predictor of
stroke and death after CABG. TEE determination of
atheroma grade is a critical
element in the management of patients undergoing CABG surgery.