Wareing T H, Davila-Roman V G, Daily B B, Murphy S F, Schechtman K B, Barzilai B, Kouchoukos N T
Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri.
Ann Thorac Surg. 1993 Jun;55(6):1400-7; discussion 1407-8. doi: 10.1016/0003-4975(93)91079-3.
Atherosclerosis of the ascending aorta (AAA) and severe carotid artery disease are risk factors for stroke in cardiac surgical patients. Twelve hundred of a consecutive series of 1,334 patients 50 years of age or older having a cardiac operation were screened for the presence of AAA by intraoperative ultrasonographic scanning and for the presence of carotid artery occlusive disease (791 of 798 patients > or = 65 years of age and younger symptomatic patients) by carotid duplex scanning. Coronary artery disease was present in 88% of the patients. Patients with moderate or severe AAA (n = 231; 19.3% of the total) were treated by ascending aortic replacement (n = 27) or by modified, less extensive techniques (n = 168) to avoid the atherosclerotic areas. Thirty-three patients had combined carotid endarterectomy and cardiac operation. Thirty-day mortality and stroke rates for the 1,200 patients were 4.0% and 1.6%, respectively. The stroke rate was low (1.1%) among the 969 patients with no or mild AAA. It was zero among 27 patients with moderate or severe AAA who had ascending aortic replacement and among the 33 patients who had carotid endarterectomy. The stroke rates were higher for 111 patients with moderate or severe ascending aortic disease who had only minor interventions (6.3%) and for 16 patients with severe carotid artery disease who did not have carotid endarterectomy (18.7%). Screening for AAA and carotid artery disease and aggressive surgical treatment of moderate or severe AAA and severe or symptomatic carotid artery disease appears to reduce the frequency of stroke in older cardiac surgical patients.
升主动脉粥样硬化（AAA）和严重颈动脉疾病是心脏手术患者发生中风的危险因素。在连续的1334例50岁及以上接受心脏手术的患者中，1200例通过术中超声扫描筛查AAA的存在，798例年龄≥65岁及症状较轻的患者中的791例通过颈动脉双功扫描筛查颈动脉闭塞性疾病的存在。88%的患者存在冠状动脉疾病。中度或重度AAA患者（n = 231；占总数的19.3%）接受了升主动脉置换术（n = 27）或改良的、范围较小的技术治疗（n = 168），以避开动脉粥样硬化区域。33例患者同时进行了颈动脉内膜切除术和心脏手术。1200例患者的30天死亡率和中风发生率分别为4.0%和1.6%。在969例无AAA或轻度AAA的患者中，中风发生率较低（1.1%）。在27例接受升主动脉置换术的中度或重度AAA患者以及33例接受颈动脉内膜切除术的患者中，中风发生率为零。仅接受小手术的111例中度或重度升主动脉疾病患者的中风发生率较高（6.3%），未接受颈动脉内膜切除术的16例严重颈动脉疾病患者的中风发生率也较高（18.7%）。筛查AAA和颈动脉疾病，并对中度或重度AAA以及重度或有症状的颈动脉疾病进行积极的手术治疗，似乎可以降低老年心脏手术患者中风的发生率。
