30-‑05-‑11 ¡ 1 ¡
A R N O N I E R I C H , W O U T E R J A N S E N K L O M P , L I N D A P E E L E N , G E O R G E B R A N D O N B R A V O B R U I N S M A A R N O U D V A N T H O F F
ISALA CLINICS, ZWOLLE, NETHERLANDS UNIVERSITY MEDICAL CENTER UTRECHT, JULIUS CENTER FOR HEALTH SCIENCES AND PRIMARY CARE, DEPARTMENT OF EPIDEMIOLOGY, UTRECHT, NETHERLANDS
Clinical outcome after pre-incision assessment of aortic atherosclerosis by A-View echocardiography in 5,553 elective cardiac surgery patients
Aim Study
To determine the diagnostic effect of the introduction of
A-View on clinical outcome
Question:
A-View postoperative reduction in 30 Day Mortality?
Primary endpoint: 30 day mortality Secondary endpoint
clinical neurological event (CVA = any CT <30 days after surgery) Combined mortality and CVA
Stroke and Encephalopathy After Cardiac Surgery An Update
Guy M. McKhann, et al. Stroke. 2006;37:562-571
7% ¡ 3% ¡ 30% ¡ 60% ¡ ?? ¡ Death ¡ Stroke ¡ Delirium ¡ Cogni;ve ¡dysfunc;on ¡ Demen;a ¡ Stroke and Encephalopathy After Cardiac Surgery An Update
Guy M. McKhann, et al. Stroke. 2006;37:562-571
0% 2% 4% 6% 8% 10% 12% 50 55 60 65 70 75 80 85
Age
Reeks2 Reeks1
Stroke Death
Etiology Aortic Source
Perioperative Stroke
Magdy Selim. N Engl J Med 2007;356:706-13
Blind spot by TEE
Meta-analysis of the diagnostic accuracy of transesophageal echocardiography for assessment of atherosclerosis in the ascending aorta in patients undergoing cardiac surgery
B Van Zaane, et al. Acta Anaesthesiol Scand 2008; 52: 1179– 1187
Visualization of the Distal Ascending Aorta With A-Mode Transesophageal Echocardiography
- A. Nierich, et al. Journal of Cardiothoracic and Vascular
Anesthesia, Vol 22, No 5 , 2008: pp 766-773
Diagnostic accuracy of modified transoesophageal echocardiography for pre- incision assessment of aortic atherosclerosis in cardiac surgery patients
B Van Zaane, et al. BJA June 10, 2010
Imaging of the distal ascending aorta using modified transesophageal echocardiography in cardiac surgery
B Van Zaane PhD dissertation 5 nov 2009
Cost-effectiveness analysis of modified transoesophageal echocardiography to assess the distal ascending aorta before incision in cardiac surgery patients.
Nierich, EACTA 2010. Koffijberg et al. Medical Decision Making submited.