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The Journal of Thoracic and Cardiovascular Surgery, Vol 103, 1104-1111, Copyright © 1992 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
CI Blauth, DM Cosgrove, BW Webb, NB Ratliff, M Boylan, MR Piedmonte, BW Lytle and FD Loop
As the ages of patients undergoing cardiac operations have increased,
noncardiac causes of death have increased. To identify these causes of
death, we analyzed the autopsy findings in 221 patients undergoing
myocardial revascularization or valve operations between 1982 and 1989.
Mean age was 65.6 +/- 9.5 years and the range was from 32 to 94 years; 130
patients (58.8%) were male. Autopsies were complete in 129 patients (58.4%)
and limited to the chest and abdomen in the remainder. Embolic disease was
identified in 69 patients (31.2%). Atheroemboli or abnormalities consistent
with atheroemboli were identified in 48 patients (21.7%). Fourteen patients
had thromboembolism and 7 had disseminated intravascular coagulation. The
prevalence of atheroembolic disease increased dramatically from 4.5% in
1982 to 48.3% in 1989 (p = 0.001). Atheroembolic disease was found in the
brain in 16.3% of patients, spleen in 10.9%, kidney in 10.4%, and pancreas
in 6.8%. Thirty (62.5%) of the 48 patients had multiple atheroembolic
sites. Atheroemboli were more common in patients undergoing coronary artery
procedures (43/165; 26.1%) than in those undergoing valve procedures (5/56;
8.9%) (p = 0.008). There was a high correlation of atheroemboli with severe
atherosclerosis of the ascending aorta. Atheroembolic events occurred in 46
of 123 patients (37.4%) with severe disease of the ascending aorta but in
only 2 of 98 patients (2%) without significant ascending aortic disease (p
less than 0.0001). Forty-six of 48 patients (95.8%) who had evidence of
atheroemboli had severe atherosclerosis of the ascending aorta. There was a
direct correlation between age, severe atherosclerosis of the ascending
aorta, and atheroemboli. Incremental risk factors for atheroembolic are
peripheral vascular disease and severe atherosclerosis of the ascending
aorta.
ARTICLES
Atheroembolism from the ascending aorta. An emerging problem in cardiac surgery
Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, OH 44195-5066.
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