What is the clinical evidence from this study?

Study design: Review. Population: Cardiac surgical conditions. Intervention: Epiaortic ultrasonographic (EAU) examination.

What question did this study set out to answer?

To establish evidence-based guidelines, standardized imaging planes, training requirements, and grading criteria for intraoperative epiaortic ultrasonography to prevent embolic stroke during cardiac surgery.

April 16, 2008Anesthesia & Analgesia

Guidelines for the Performance of a Comprehensive Intraoperative Epiaortic Ultrasonographic Examination: Recommendations of the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists; Endorsed by the Society of Thoracic Surgeons

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To establish evidence-based guidelines, standardized imaging planes, training requirements, and grading criteria for intraoperative epiaortic ultrasonography to prevent embolic stroke during cardiac surgery.
Expert consensus recommendations developed by the American Society of Echocardiography and Society of Cardiovascular Anesthesiologists, endorsed by the Society of Thoracic Surgeons.
Synthesis of clinical literature assessing stroke risks, transesophageal echocardiography blind spots, direct epiaortic ultrasound imaging protocols, and atheroma classification systems.
Definition of a 5-view imaging protocol utilizing high-resolution (>7 MHz) transducers in sterile operative fields.
Epiaortic ultrasound significantly outperforms surgical palpation, identifying atheromatous disease in 58% of coronary bypass patients compared to 24% by manual palpation.
Standard protocol mandates a minimum of five views: three short-axis views (proximal, mid, distal ascending aorta) and two long-axis views (ascending aorta and proximal aortic arch).
Plaque height exceeding 3 mm and mobile atheroma components confer the highest risk for adverse neurologic outcomes, requiring immediate communication with surgical teams before aortic manipulation.

Structured PICO

Population

Patients with cardiac surgical conditions, primarily those with an increased risk for embolic stroke (including history of cerebrovascular or peripheral vascular disease, or evidence of aortic atherosclerosis/calcification by other imaging modalities).

Intervention

Comprehensive intraoperative epiaortic ultrasonographic (EAU) examination using a high-resolution (>7 MHz) ultrasound transducer.

This guideline establishes standardized protocols and indications for intraoperative epiaortic ultrasonography to assess aortic atherosclerosis and reduce perioperative stroke risk in cardiac surgery.

Limitations

No prospective, randomized clinical trial has evaluated the relationship between stroke rate and EAU-altered surgical technique.
Cross-validation between studies is hampered by inconsistencies in population studied, equipment used, location of aorta assessed, and definition of adverse outcome.
Some grading systems use subjective echocardiographic descriptions of atheroma that are difficult to quantify.

Discussion

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Implication

Supports epiaortic ultrasonography for aortic assessment in high-risk cardiac surgery; extends standardized protocols to reduce perioperative stroke.

Cite This Study

Glas et al. (2008) conducted a review in Cardiac surgical conditions. Epiaortic ultrasonographic (EAU) examination was evaluated. Epiaortic ultrasonographic imaging is recommended to identify and manage aortic atheromatous disease in cardiac surgery patients at increased risk for embolic stroke.

synapsesocial.com/papers/6a79ad8ca51ded8e7b325166 https://doi.org/10.1213/ane.0b013e31816a6b4c

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Implication

Supports epiaortic ultrasonography for aortic assessment in high-risk cardiac surgery; extends standardized protocols to reduce perioperative stroke.

Guidelines for the Performance of a Comprehensive Intraoperative Epiaortic Ultrasonographic Examination: Recommendations of the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists; Endorsed by the Society of Thoracic Surgeons

Key Points

Structured PICO

Limitations

Discussion

Implication

Cite This Study

Guidelines for the Performance of a Comprehensive Intraoperative Epiaortic Ultrasonographic Examination: Recommendations of the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists; Endorsed by the Society of Thoracic Surgeons

Key Points

Structured PICO

Limitations

Discussion

Implication

Cite This Study

Also Consider

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