Retrospective Analysis of Cerebral Complications After Coronary Artery Bypass Grafting in Elderly Patients

Yoshihiro Morino; Kazuhiro Hara; Kengo Tanabe; Yuzo Kuroda; Seiji Ayabe; Ken Kozuma; Ikutaro Kigawa; Sachito Fukuda; Yasuhiko Wanibuchi; Tsutomu Tamura

doi:10.1253/jcj.64.46

Clinical Studies

Retrospective Analysis of Cerebral Complications After Coronary Artery Bypass Grafting in Elderly Patients

Yoshihiro Morino, Kazuhiro Hara, Kengo Tanabe, Yuzo Kuroda, Seiji Ayabe, Ken Kozuma, Ikutaro Kigawa, Sachito Fukuda, Yasuhiko Wanibuchi, Tsutomu Tamura

Author information

Yoshihiro Morino
Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
Kazuhiro Hara
Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
Kengo Tanabe
Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
Yuzo Kuroda
Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
Seiji Ayabe
Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
Ken Kozuma
Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
Ikutaro Kigawa
Division of Cardiovascular Surgery, Mitsui Memorial Hospital, Tokyo, Japan
Sachito Fukuda
Division of Cardiovascular Surgery, Mitsui Memorial Hospital, Tokyo, Japan
Yasuhiko Wanibuchi
Division of Cardiovascular Surgery, Mitsui Memorial Hospital, Tokyo, Japan
Tsutomu Tamura
Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan

Keywords: Cerebral complication, Cerebral infarction, Coronary artery bypass grafting (CABG), Elderly patients, Stroke

JOURNAL FREE ACCESS

2000 Volume 64 Issue 1 Pages 46-50

DOI https://doi.org/10.1253/jcj.64.46

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Abstract

The present study retrospectively investigated cerebral complications of coronary artery bypass grafting in 205 consecutive patients aged 70 years or older, who underwent elective cardiopulmonary bypass from 1990 to 1997. Computed tomography of the brain and chest was done before surgery. Ten patients had so-called ‘aortic notouch surgery’ and suffered no cerebral complications; the other 195 patients had conventional surgery. Adverse cerebral events occurred in 8.7%, including cerebral infarction (4.1%), diffuse encephalopathy (1.0%), convulsions (1.0%), transient disturbance of consciousness (1.0%), and severe loss of volition (1.5%). Multivariate analysis showed that only the detection of calcification of the ascending aorta was significantly associated with cerebral complications (p=0.029). Total clamping tended to be superior to partial clamping for prevention of cerebrovascular accidents. The mortality rate was 7.3%. In-hospital death was related to age (p=0.0062), cerebral complications (p=0.0032), and a low left-ventricular function (p=0.018). Therefore, chest computed tomography to assess the ascending aorta should be performed preoperatively. Modified techniques like aortic no-touch surgery or other therapies combined with coronary intervention may be needed in elderly patients with severe calcification of the ascending aorta.

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