Risk factors for ascending aortic atheromatosis--a retrospective analysis of 2,263 patients undergoing coronary artery bypass surgery.

Background and aims: Ascending aortic atherosclerosis has been recognised as a potential source of atheroembolization during coronary artery bypass operation. A set of possible predictive preoperative factors for ascending aortic atheromatosis was studied to find the patients at greatest risk for aortic atheromatosis.

Material and methods: The records of 2,263 patients undergoing first-time coronary bypass operation from January 1993 to December 1995 were reviewed. Ascending aortic atheromatosis was considered to be present if the operating surgeon detected atheromatosis in ascending aorta by palpation or by sight while making aortotomies.

Results: Ascending aortic atheromatosis was found in 9.1% of the patients. Significant predictors in the multivariate model were age, tobacco use, diabetes, peripheral vascular disease, renal failure, chronic obstructive pulmonary disease, x-ray calcifications of the thoracic aorta and subclavian artery stenosis at minimum 50 %. The loose variety of atheromatosis was detected by sight while making aortotomies in 1.1% of patients. Significant predictors in the multivariate model for this loose variety were age, hyperlipidemia and renal failure. Patients with ascending aortic atheromas suffered significantly more perioperative myocardial infarcts and central neurological defects as well as succumbed more often.

Conclusion: This study defines some groups of coronary bypass patients that have increased risk for ascending aortic atheromatosis. Special attention should be paid to them during coronary bypass operation in order to minimise the otherwise increased risk for adverse neurological and cardial outcome.