The Rationalisation of Intra-Operative Imaging During Cardiac Surgery: A Systematic Review
Mona Jaffar-Karballaia b, Fatima Kayalic, Bianca Botezatud, Danish Iltaf Sattie, Amer Harkyf g h✉
- aDepartment of Medicine, St George's University of London, London, UK
- bDepartment of Medicine, St George’s University of London, London, UK
- cSchool of Medicine, University of Central Lancashire, Preston, UK
- dQueen's University Belfast, School of Medicine, Dentistry and Biomedical Sciences, Belfast, Northern Ireland
- eShifa College of Medicine, Shifa Tameer-e-millat University, Islamabad, Pakistan
- f
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Abstract
INTRODUCTION One critical complication of cardiac surgery is cerebrovascular accidents (CVAs). Ascending aorta atherosclerosis poses a significant risk of embolisation to distal vessels and to cerebral arteries. Epi-aortic ultrasonography (EUS) is thought to offer a safe, high-quality accurate visualisation of the diseased aorta to guide the surgeon on the best surgical approach to the planned procedure and potentially improve neurological outcomes post-cardiac surgery. METHOD The authors conducted a comprehensive search of PubMed, Scopus and Embase. Studies that reported on epi-aortic ultrasound use in cardiac surgery were included. Major exclusion criteria were: (1) abstracts, conference presentations, editorials, literature reviews; (2) case series with <5 participants; (3) epi-aortic ultrasound in trauma or other surgeries. RESULTS A total of 59 studies and 48,255 patients were included in this review. Out of the studies that reported patient co-morbidities prior to cardiac surgery, 31.6% had diabetes, 59.5% had hyperlipidaemia and 66.1% had a diagnosis of hypertension. Of those that reported significant ascending aorta atherosclerosis found on EUS, this ranged from 8.3% of patients to 95.2% with a mean percentage of 37.8%. Hospital mortality ranged from 7% to 13%; four studies reported zero deaths. Long-term mortality and stroke rate varied significantly with hospital duration. CONCLUSION Current data have shown EUS to have superiority over manual palpation and transoesophageal echocardiography in the prevention of CVAs following cardiac surgery. Yet, EUS has not been implemented as a routine standard of care. Extensive adoption of EUS in clinical practice is warranted to aid large, randomised trials before making prospective conclusions on the efficacy of this screening method.
TL;DRCurrent data have shown EUS to have superiority over manual palpation and transoesophageal echocardiography in the prevention of CVAs following cardiac surgery, yet EUS has not been implemented as a routine standard of care. (Semantic Scholar)