A Protocol for Diagnosis and Management of Aortic Atherosclerosis in Cardiac Surgery Patients

Abstract

In patients undergoing cardiac surgery, use of perioperative screening for aortic atherosclerosis with modified TEE (A-View method) was associated with lower postoperative mortality, but not stroke, as compared to patients operated on without such screening. At the time of clinical implementation and validation, we did not yet standardize the indications for modified TEE and the changes in patient management in the presence of aortic atherosclerosis. Therefore, we designed a protocol, which combined the diagnosis of atherosclerosis of thoracic aorta and the subsequent considerations with respect to the intraoperative management and provides a systematic approach to reduce the risk of cerebral complications.

Figure 1

Flowchart of the diagnostic and therapeutic management of aortic atherosclerosis in cardiac surgery.

Figure 2

Example of a vascular report in the preoperative screening for possible aortic valve replacement in a patient with severe aortic stenosis. (Modified) TEE showed extensive calcifications of the complete thoracic aorta; it was therefore concluded to perform a transapical aortic valve replacement to minimize manipulation of the aorta.