Khamtuikrua Chaowanan, Chaikittisilpa Nophanan, Suksompong Sirilak, Slisatkorn Worawong, Raykateeraroj Nattaya
Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Division of Cardio-Thoracic Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Heliyon. 2024 Aug 21;10(16):e36607. doi: 10.1016/j.heliyon.2024.e36607. eCollection 2024 Aug 30.
Cerebral embolism, a serious complication in cardiac surgery, is significantly impacted by atheromatous plaques in the ascending aorta and aortic arch. However, data on the prevalence of these plaques in Asian populations are sparse. This study aimed to evaluate the prevalence of atheromatous plaques in the ascending aorta among Thai cardiac surgery patients, thereby facilitating risk stratification and improving preoperative management. We conducted intraoperative epiaortic ultrasound examinations on 239 cardiac surgery patients. Clinically significant atheromatous plaques were defined as those exceeding 3.0 mm in thickness. The collected demographic and clinical data included sex, age, body weight, height, American Society of Anesthesiologists physical status classification, smoking status, alcohol consumption, and comorbidities. Atheromatous plaques were found in 33.5 % of the ascending aortas and 41.4 % of the aortic arches. The primary risk factors were advanced age (over 80 years; relative risk (RR) 1.444, 95 % confidence interval (CI) 1.113-1.874, = 0.006) and carotid stenosis (RR 1.247, 95 % CI 1.04-1.495, = 0.017). The prevalence of atheromatous plaques in Thai cardiac surgery patients was significant, with older age and carotid stenosis being major risk factors. Preoperative aortic imaging, such as computed tomography angiography or epiaortic ultrasound, should be applied to cardiac surgery candidates. In resource-limited settings, prioritizing patients of advanced age or those with carotid stenosis for imaging is advised.
脑栓塞是心脏手术中的一种严重并发症，升主动脉和主动脉弓处的动脉粥样硬化斑块对其有显著影响。然而，关于这些斑块在亚洲人群中的患病率数据却很稀少。本研究旨在评估泰国心脏手术患者升主动脉中动脉粥样硬化斑块的患病率，从而有助于风险分层并改善术前管理。我们对239例心脏手术患者进行了术中主动脉外膜超声检查。临床上有意义的动脉粥样硬化斑块定义为厚度超过3.0毫米的斑块。收集的人口统计学和临床数据包括性别、年龄、体重、身高、美国麻醉医师协会身体状况分类、吸烟状况、饮酒情况和合并症。在33.5%的升主动脉和41.4%的主动脉弓中发现了动脉粥样硬化斑块。主要危险因素是高龄（超过80岁；相对风险（RR）1.444，95%置信区间（CI）1.113 - 1.874， = 0.006）和颈动脉狭窄（RR 1.247，95% CI 1.04 - 1.495， = 0.017）。泰国心脏手术患者中动脉粥样硬化斑块的患病率很高，高龄和颈动脉狭窄是主要危险因素。对于心脏手术候选者，应进行术前主动脉成像检查，如计算机断层血管造影或主动脉外膜超声检查。在资源有限的情况下，建议优先对高龄患者或有颈动脉狭窄的患者进行成像检查。
