Choice of hemodynamic support during coronary artery bypass surgery for prevention of stroke

Abstract

The objective of this study was to evaluate a protocol involving cerebrovascular accident (CVA) risk evaluation and choose adequate hemodynamic support that prevents major CVA. For evaluation of CVA risk, we undertook head computed tomography (CT), magnetic resonance imaging (MRI), magnetic resonance angiography (MRA), chest CT, carotid artery Doppler echo, carotid artery MRA, and echo scanning of ascending aorta during surgery. Cerebrovascular specialists did the physical examinations and reading of images. Hemodynamic support (chemical arrest on pump, on-pump beating, or off pump) was chosen according to the result of risk evaluation. We retrospectively studied 92 cases before (group A; 1997 October to 1998 November) and 91 after (group B; 1998 November to 2001 January) starting protocol. We also studied urgent cases (group C; 9 cases; 1997 October to 2001 January) in which we did not use the protocol. When adequate hemodynamic support was chosen, major CVA (modified Rankin scale grades 3, 4, and 5) incidence decreased from 6.6% (six case; group A) to 0% (p < .05; group B). There were three major CVA cases in group C (p < .05 vs. group B), in which the ascending aorta was clamped. Our protocol eliminated major CVA associated with elective coronary surgery. We need simpler evaluation, however, when we undertake urgent surgery.