升主动脉隔离装置在升主动脉近端钙化患者非体外循环冠状动脉旁路移植术中的应用

目的 评价升主动脉近端隔离装置(Heartstring和Enclose近端吻合装置)在非体外循环冠状动脉旁路移植术(OPCAB)中的应用效果. 方法 2006年1月至2008年2月收治了150例合并升主动脉近端钙化的冠心病患者,其中男102例,女48例;年龄55～78岁,平均年龄69岁.所有患者在冠状动脉旁路移植术中应用升主动脉近端隔离装置,大隐静脉与升主动脉近端共完成251个吻合口,升主动脉近端吻合口1～3个/例,大隐静脉桥血管完成后应用流量仪进行流量测定.术后观察神经系统并发症的发生情况. 结果 术后死于低心排血量综合征1例(0.67%);二次开胸止血2例,其中1例为乳内动脉床渗血,1例为胸骨后出血;其余患者术后24 h胸腔引流量为100～200 ml.所有患者均于术后24～48 h内顺利拔除气管内插管;术后均未出现明确的昏迷、肢体偏瘫、语言障碍及运动不协调等神经系统并发症;大隐静脉桥血流量为28.5～70.1 L/min(53.7± 23.9 L/min).术后随访145例,随访率97.32%,随访时间3个月～1年;4例失访.随访期间患者未发生迟发性脑出血或脑梗死等神经系统并发症.结论 在OPCAB术中应用Heartstring和Enclose升主动脉近端隔离装置,安全、有效,能有效地降低脑卒中的发生率.     

水囊封堵法用于非体外循环冠状动脉旁路移植术近端吻合的近中期疗效观察

目的 对水囊封堵法用于严重升主动脉钙化的冠状动脉粥样硬化性心脏病患者非体外循环冠状动脉旁路移植术(OPCAB)近端吻合的近、中期疗效进行评估.方法 选择2005年1月至2009年5月收治的升主动脉存在严重钙化的OPCAB患者31例,作为实验组,采用水囊封堵方法进行近端吻合;其中男性23例,女性8例,年龄(69±8)岁.随机选取升主动脉无钙化的同期接受OPCAB的患者63例作为对照组,采用升主动脉侧壁钳进行近端吻合;其中男性39例,女性24例,年龄(60±9)岁.比较两组患者术前及术后3个月的相关心功能指标,并对近、中期疗效进行随访.结果 两组患者无手术死亡.术后对照组脑卒中发生率与实验相比差异无统计学意义.术后3个月随访时患者均无症状,心功能及射血分数均有提高(P＜0.05),左心室舒张末期内径缩小(P＜O.05).随访截至2009年11月底,患者随访率为91.5%,存活率96.0%.7例患者于术后2年以上接受了冠状动脉造影检查,显示近端吻合口通畅.结论 在对严重升主动脉钙化患者行近端吻合时,水囊封堵法操作简单,近中期疗效确切、安全性高,具有广泛的应用和推广价值.     

升主动脉前壁弥漫钙化患者冠状动脉旁路移植策略

目的探讨合并弥漫性升主动脉前壁钙化的冠心病患者冠状动脉旁路移植术策略。方法回顾性分析2011年9月至2012年6月30例升主动脉前壁弥漫钙化的冠心病患者的冠状动脉旁路移植手术策略,男21例、女9例,年龄60~75岁。所有患者均行非体外循环冠状动脉旁路移植术(OPCAB)。结果术后住院时间(8.7±3.2)d,围术期无死亡,无心脑血管意外,无伤口及纵隔感染。围术期主要并发症为心房颤动,发生率23.3%。术后30 d常规复查所有患者心绞痛症状均消失或改善,心功能改善。结论对于升主动脉前壁有弥漫钙化的冠心病患者,采用OPCAB方式,多种方法联合应用,可尽量避免或减少升主动脉前壁的刺激,减少手术风险,实现最大限度的目标冠状动脉再血管化。     

冠状动脉旁路移植术253例

目的 总结17年成人冠状动脉旁路移植术(CABG)的临床经验.方法 自1987年4月至2004年5月,共施行CABG 253例,其中217例行体外循环(CPB)CABG,10例升主动脉壁钙化的患者行升主动脉壁Gore-Tex人工血管片部分置换,以供旁路移植血管近端吻合;行非体外循环冠状动脉旁路移植术(OPCAB)30例,不降温、体外并行循环心脏不停跳下手术6例.同期行心瓣膜手术15例,左心房粘液瘤摘除术1例,室壁瘤切除术10例.结果 本组住院死亡20例(7.9%,20/253).前10年死亡率(16.0%,8/50)显著高于近7年的死亡率(5.9%,12/203;χ2=5.62,P＜0.05).死亡原因包括心瓣膜置换术后发生低心排血量行急诊CABG,仍然无法脱离CPB 3例,多器官功能衰竭2例,关胸时发生心室颤动再次在CPB下增加旁路血管移植支数仍无效3例,发生严重肺部感染、呼吸功能衰竭导致多器官功能衰竭6例,术后发生严重室性心律失常抢救无效2例,急性肾功能衰竭4例.随访157例(67.4%,157/233),随访时间6个月～15年,远期死亡3例,死亡原因不明;大多数患者心功能和生活质量明显改善,心功能(NYHA)Ⅰ级87例,Ⅱ级49例,Ⅲ级16例,Ⅳ级2例.结论 随着手术和术后治疗经验的成熟,CABG已成为治疗冠心病患者较为安全、可靠的治疗方法;Gore-Tex血管片部分置换钙化的升主动脉壁为旁路移植血管的近端吻合提供了新的方法.     

Heartstring无阻断近端吻合系统在OPCAB术中的应用

神经系统并发症是冠状动脉旁路移植（冠脉搭桥）术后最常见的并发症之一,多因术中行升主动脉操作造成内膜斑块脱落引发.随着非体外循环下冠状动脉旁路移植术（OPCAB）的广泛开展,因主动脉插管造成的冠脉搭桥术后神经系统并发症的概率明显下降.但大隐静脉仍是绝大多数冠脉搭桥术的主要选材,需要在升主动脉上进行外科钳夹及打孔操作,因此,主动脉斑块脱落仍然是术后神经系统并发症的主要原因之一.近年来,大量的桥血管近端吻合辅助器械应运而生.现将我们对60例行OPCAB病人应用Heartstring主动脉近端吻合器的经验和体会报道如下.     

水囊封堵法对比Heartstring用于非体外循环冠状动脉旁路移植术近端吻合的早期疗效

目的对比水囊封堵法与Heartstring对合并钙化升主动脉行近端吻合的早期疗效。方法回顾性分析2022年1月至2022年6月期间北京安贞医院连续收治的择期行非体外循环冠状动脉旁路移植术(OPCABG)的400例患者临床资料。经术前胸部CT平扫及术中触诊, 明确合并升主动脉钙化的患者46例, 其中男40例, 女6例;年龄53～73岁, 平均(65.2±5.1)岁;根据近端吻合的方式, 将患者分为水囊封堵法组(19例)和Heartstring组(27例)。统计两组术后卒中发生率, 对比两种方法预防术后卒中的效果。通过术中检测大隐静脉旁路移植血管主干血流量及搏动指数, 术后48 h内观察心电图、肌钙蛋白的动态变化, 以及术后3个月复查冠状动脉CTA, 比较两种方法用于近端吻合的疗效。结果全组均无围手术期死亡, 术后4～13天出院。围手术期无卒中、恶性室性心律失常等不良事件发生。两组各有1例术后出现低心排血量综合征, 放置IABP后均好转。Heartstring组术后1例出现急性下壁心肌梗死, 放置IABP后好转。术后3个月复查冠状动脉CTA, 两组均未发生近端吻合口狭窄。结论水囊封堵法和H...     

国人桥血流搏动指数的研究

目的　研究冠状动脉旁路移植术 (CABG)国人桥血流的搏动指数 (PI值 )合适的范围。方法　将 35 7例CABG病人分为二组 ,不停跳 (OPCAB)组 2 6 3例 ,停跳 (CCABG)组 94例。常规用原位带蒂左乳内动脉 (LIMA)与左前降支 (LAD)吻合 (LIMA组 ) ,其余桥使用大隐静脉 (SV组 )。SV吻合口多于 2个时采用序贯式吻合 ,近端吻合于升主动脉。移植完毕动脉血压稳定后 ,用直径为 2～ 3mm超声微探头直接测量LIMA和SV桥的平均血流量、收缩期和舒张期血流量以及PI值 ,并记录血流波形。确定PI值“合适”的标准 :舒张期血流波形良好 ;平均血流量大于 10ml min ;术中及术后CK MB、cTnI在正常范围和无ECG改变及手术后临床症状改善等。结果　各组测量桥血流时血压差异无显著性。共测量LIMA 35 7根 ,SV 32 4根。LIMA之PI值 :OPCAB为 2 4 9± 0 91,CCABG为 2 39± 1 16 ;SV之PI值 :OPCAB为 2 6 8±1 35 ,CCABG为 2 5 9± 1 4 2 ;各组间PI值差异无显著性 (P >0 0 5 )。用全部PI值计算出总体平均值为2 5 6± 2 35 (95 %置信度 )。结论　国人冠状动脉旁路移植术桥血流的PI的参考值范围为小于 5。     

正中切口解剖外旁路移植术一期治疗主动脉缩窄合并心脏畸形

目的总结正中切口解剖外旁路移植术一期治疗主动脉缩窄合并心脏畸形的外科治疗经验,以提高手术疗效。方法1997年7月至2008年7月,采用正中切口解剖外旁路移植术一期治疗主动脉缩窄合并心脏畸形31例,其中男20例,女11例;年龄31．9±11．7岁。合并的心脏畸形包括：主动脉瓣狭窄或关闭不全22例,二尖瓣狭窄或关闭不全9例,动脉导管未闭5例,升主动脉瘤4例,室间隔缺损3例,冠心病2例。解剖外旁路移植术包括升主动脉-腹主动脉旁路移植术22例,升主动脉-心包后降主动脉旁路移植术9例。同期手术包括主动脉瓣置换术16例,主动脉根部置换术6例,二尖瓣成形或置换术9例,升主动脉置换或成形术4例,动脉导管未闭缝合术5例,室间隔缺损修补术3例,冠状动脉旁路移植术2例。结果住院死亡1例（3．2％）,术后39d死于感染性中毒性休克。术后上、下肢收缩压压差较术前明显下降（13．7±10．2mmHg vs．64．2±25．3mmHg,P〈0．05）。随访27例,随访时间4～73个月,无晚期死亡、与人工血管相关的并发症和再次手术患者。结论正中切口解剖外旁路移植术是一期治疗成人及青少年主动脉缩窄合并心脏畸形的一种安全有效的手术方法。升主动脉腹主动脉旁路移植术及升主动脉-心包后降主动脉旁路移植术均可获得满意疗效。     

升主动脉-腹主动脉旁路移植术治疗Ⅱ、Ⅲ型大动脉炎

目的：为了有效治疗累及胸腹主动脉的Ⅱ、Ⅲ型大动脉炎，探讨升主动脉－腹主动脉旁路移植术的手术疗效。方法：自1976年至2001年采用升主动脉－腹主动脉旁路移植术治疗Ⅱ、Ⅲ型大动脉炎47例，同期行人工血管与肾动脉旁路移植术10例，冠状动脉旁路移植术和自体肾移植术各2例，三尖瓣成形术和髂动脉旁路移植术各1例。结果：术后1例死于凝血障碍出血，死亡率为2．13％；术后因肠梗阻再1列；存活患者血压和血运均明显改善，上肢血压较术前明显下降，平均为118／77mmHg(1kPa=7.5mmHg)vs 177/83mmHg；术后上、下肢血压差别无显著性意义。平均随访8．2年，远期死亡2例（4．35％），再手术1例，远期效果优良率为81．82％。结论：升主动脉－腹主动脉旁路移植术是治疗Ⅱ、Ⅲ型大动脉炎的简单、安全、远期疗效好的方法。     

经胸降主动脉微创冠状动脉旁路移植术

目的 探讨胸腔镜辅助左胸小切口、经胸降主动脉"Y"形旁路血管向心肌供血,实施非体外循环冠状动脉旁路移植术微创化的临床疗效.方法 66例冠心病病人,经左胸小切口开胸,胸腔镜游离左侧乳内动脉,经胸降主动脉"Y"形旁路血管向心肌供血,实施非体外循环冠状动脉旁路移植术,用瞬时流量测定仪检测旁路血管的通畅度.结果 平均手术(103,0±18.4)min.术后平均机械辅助呼吸(5.6±3.2)h,平均ICU滞留(37.3±7.6)h,平均胸腔引流量(190±75)ml,平均输血(150±50)ml,移植血管平均流量Qm为(27±7)mi/min,搏动指数(PI)为3.5±1.4,逆向血流百分比(%Insuf)为(7±5)%.全组病人无死亡,均治愈出院.随访12～48个月,病人病情稳定,身体状况良好.结论 该术式是微创冠状动脉旁路移植术的一个新途径.尤其适用于升主动脉存在钙化、扩张或粥样硬化斑块者,可避免升主动脉损伤、附壁斑块松动、脱落导致的脑栓塞或冠状动脉栓塞.安全、有效、创伤小.从真正意义上实现了冠状动脉旁路移植术的微创化.临床疗效显著,近期效果满意,远期效果有待进一步随访观察.     

Results with the Heartstring anastomotic device in patients with diseased ascending aorta

BACKGROUND: Avoidance of manipulation of diseased ascending aorta has been shown to be associated with a reduced risk of postoperative stroke after off-pump coronary artery bypass surgery (OPCAB). The use of the Heartstring device (Guidant, Indianapolis, USA) to accomplish a proximal aortic anastomosis without aortic clamping has been suggested in such patients. PATIENTS AND METHODS: From April 2004 to December 2005, proximal aortic anastomoses have been accomplished employing the Heartstring device in 19 patients with calcified ascending aorta who underwent OPCAB. The diagnosis of diseased ascending aorta was made intraoperatively by epiaortic ultrasound scanning. RESULTS: Eighteen vein grafts and three radial artery grafts have been successfully anastomosed to the ascending aorta by employing the Heartstring device. Breaking of eight seals occurred during insertion. One patient (5.2%) had stroke two days after urgent OPCAB. CONCLUSION: The use of the Heartstring anastomotic device should be considered in high-risk patients with diseased ascending aorta requiring a prompt myocardial revascularization, whenever there is a place to safely insert this device into the ascending aorta.     

Risk of retinal microembolism after off-pump and on-pump coronary artery bypass surgery

AIM: In order to investigate the neuroprotective efficacy of off-pump coronary artery bypass surgery (OPCAB) over conventional on-pump coronary artery bypass surgery (CCAB), we have performed a prospective randomized study evaluating retinal circulation changes after OPCAB and CCAB. METHODS: Twenty patients were randomized to OPCAB or CCAB. Retinal fluorescein angiography and 60 degrees black-and-white as well as color fundus photographs of both eyes of each patient were taken 1 to 24 h before and 5 to 6 days after the operation. RESULTS: Patients undergoing OPCAB had more severely stenosed carotid arteries (P=0.075), higher incidence of slightly diseased ascending aorta (P=0.087) and higher Northern New England Cardiovascular Study Group stroke risk score (P=0.075). Neither stroke nor transient ischemic attack occurred postoperatively in these patients. Inferotemporal retinal arterial embolization and microinfarction was detected in one patient after CCAB, but in none of the OPCAB group. CONCLUSION: The risk of retinal embolism can be minimized by the use of OPCAB and, most likely, by adequate epiaortic ultrasound scanning of the ascending aorta and avoiding clamping in case of severely diseased aorta.     

Symmetry aortic connector devices and acute renal injury: a comparison of renal dysfunction after three different aortocoronary bypass surgery techniques

Although the pathogenesis of acute renal injury after cardiac surgery is multifactorial, atherosclerosis of the ascending aorta and embolic burden are strong independent predictors. Use of the Symmetry aortic connector device (ACD) for proximal anastomosis of coronary grafts may reduce ascending aortic atheroembolism. Therefore, we tested the hypothesis that off-pump coronary artery bypass (OPCAB) surgery performed using an ACD is associated with less postoperative renal dysfunction compared with conventional OPCAB or on-pump coronary artery bypass graft (CABG) surgery. Three-thousand-three-hundred consecutive patients undergoing non-emergent aortocoronary bypass surgery were retrospectively divided into three groups by surgical procedure; Group A: OPCAB with ACD (n = 124), Group B: standard OPCAB (n = 313), Group C: on-pump CABG (n = 2863). Postoperative peak fractional change in creatinine compared with baseline was used as a measure of renal outcome. Multivariable analysis did not identify ACD use as an independent predictor of postoperative peak fractional change in creatinine (P = 0.71), although the relationships of several known renal risk factors with postoperative peak fractional change in creatinine were confirmed. We could not find evidence that OPCAB surgery using ACDs reduces acute renal injury compared with standard OPCAB or CABG surgery.     

升主动脉粥样硬化患者的冠状动脉旁路移植

目的 总结冠状动脉粥样硬化性心脏病合并升主动脉粥样硬化患者冠状动脉旁路移植手术的特点。方法 22例患者中,13例采用非体外循环、心脏不停跳下冠状动脉旁路移植术(59％);9例采用低温体外循环(41％),其中5例在深低温、低流量并间断停循环条件下不阻断升主动脉行旁路-升主动脉近端吻合。结果 20例康复出院,术后早期死亡2例;并发症有肺部感染、心绞痛、室颤、急性心肌梗死和血胸,无神经系统并发症。结论 减少术中升主动脉操作是防止升主动脉损伤和减少并发症的关键。应用带蒂动脉旁路、旁路远端序贯吻合和近端Y形吻合可避免或减少旁路-升主动脉吻合;低温体外循环加左心室引流时,可不阻断升主动脉行旁路远端吻合;深低温、低流量并间断停循环下行旁路-升主动脉吻合,可避免阻断和部分阻断升主动脉,利于控制并发症。     

'No touch' techniques for porcelain ascending aorta: comparison between cardiopulmonary bypass with femoral artery cannulation and off-pump myocardial revascularization

BACKGROUND: Detection of severe atherosclerotic ascending aorta during coronary artery bypass grafting requires alterations in the standard surgical technique to reduce the probability of stroke-related atheroembolization. Off-pump coronary artery bypass grafting (OPCAB) confers the benefits of avoiding aortic cannulation and clamping, and may therefore attenuate this risk. METHODS: OPCAB (n = 41) was compared to cardiopulmonary bypass (CPB) using femoral arterial cannulation and hypothermic fibrillatory arrest (n = 15), in patients with porcelain ascending aorta undergoing myocardial revascularization. In both groups, a 'no touch' technique was applied by avoiding aortic cannulation and clamping. Proximal anastomoses on the atherosclerotic aorta were avoided by arterial grafting, (in-situ or T-graft configurations) in all cases. RESULTS: Operative mortality was comparable (2.4% and 6.6% in the OPCAB and CPB groups respectively, p = NS). The rate of adverse neurological events, (two strokes and one transient ischemic attack), was higher in the CPB group (p = 0.0164). Based on brain CT, the nature of the recorded stroke suggested retrograde emboli. Three year survival (Kaplan-Meier) for the OPCAB and CPB groups was 86.7% and 81.3%, respectively (p = NS). Occurrence of late neurological adverse events during follow-up (8-51 months) was similar. CONCLUSIONS: In patients with porcelain ascending aorta undergoing myocardial revascularization, neurological outcome of OPCAB patients is better than CPB using femoral artery cannulation.     

‘No Touch’ Techniques for Porcelain Ascending Aorta: Comparison Between Cardiopulmonary Bypass with Femoral Artery Cannulation and Off‐Pump Myocardial Revascularization

Abstract Background: Detection of severe atherosclerotic ascending aorta during coronary artery bypass grafting requires alterations in the standard surgical technique to reduce the probability of stroke‐related atheroembolization. Off‐pump coronary artery bypass grafting (OPCAB) confers the benefits of avoiding aortic cannulation and clamping, and may therefore attenuate this risk. Methods: OPCAB (n # 41) was compared to cardiopulmonary bypass (CPB) using femoral arterial cannulation and hypothermic fibrillatory arrest (n = 15), in patients with porcelain ascending aorta undergoing myocardial revascularization. In both groups, a ‘no touchrsquo; technique was applied by avoiding aortic cannulation and clamping. Proximal anastomoses on the atherosclerotic aorta were avoided by arterial grafting, (in‐situ or T‐graft configurations) in all cases. Results: Operative mortality was comparable (2.4% and 6.6% in the OPCAB and CPB groups respectively, p # NS). The rate of adverse neurological events, (two strokes and one transient ischemic attack), was higher in the CPB group (p # 0.0164). Based on brain CT, the nature of the recorded stroke suggested retrograde emboli. Three year survival (Kaplan‐Meier) for the OPCAB and CPB groups was 86.7% and 81.3%, respectively (p = NS). Occurrence of late neurological adverse events during follow‐up (8–51 months) was similar. Conclusions: In patients with porcelain ascending aorta undergoing myocardial revascularization, neurological outcome of OPCAB patients is better than CPB using femoral artery cannulation.     

The atherosclerotic aorta at aortic valve replacement: surgical strategies and results

BACKGROUND: Aortic valve replacement in patients with severe atherosclerosis of the ascending aorta poses technical challenges. The purpose of this study was to examine operative strategies and results of aortic valve replacement in patients with a severely atherosclerotic ascending aorta that could not be safely crossclamped.Patients and methods: From January 1990 to December 1998, 4983 patients had aortic valve surgery; of these, 62 (1.2%) patients had a severely atherosclerotic ascending aorta and required hypothermic circulatory arrest to facilitate aortic valve replacement. They form the study group. RESULTS: All patients had hypothermic circulatory arrest, but several different strategies were used to manage the ascending aorta. These techniques included aortic valve replacement with the use of hypothermic circulatory arrest (39%), ascending aortic endarterectomy (26%), ascending aortic replacement (19%), aortic inspection and crossclamping during hypothermic circulatory arrest (10%), and balloon occlusion of the ascending aorta (6%). Duration of hypothermic circulatory arrest was substantially longer for patients having aortic valve replacement with hypothermic circulatory arrest than for all other strategies. Hospital mortality was 14%, and 10% of patients had strokes. Increasing New York Heart Association functional class and impaired left ventricular function were risk factors for hospital mortality. Choice of operative technique did not influence patient outcome; however, no patient who underwent replacement of the ascending aorta had a stroke. CONCLUSIONS: Aortic valve replacement in patients with severe atherosclerosis of the ascending aorta is associated with increased operative morbidity and mortality. Complete aortic valve replacement during hypothermic circulatory arrest, the "no-touch" technique, requires a prolonged period of circulatory arrest. Ascending aortic replacement is a preferred technique, as it requires a short period of hypothermic circulatory arrest and results in comparable mortality with a low risk of stroke.     

Topical lidocaine effectively reduced the increase of systolic blood pressure after side-clamping of the aorta in off-pump cardiac surgery

BACKGROUND: Side-clamping of the ascending aorta during off-pump coronary artery bypass surgery (OPCAB) may be associated with a significant increase in systemic blood pressure which may rarely result in aortic dissection. We evaluated whether topical application of lidocaine on the ascending aorta could reduce the rise in systemic blood pressure during side-clamping of the aorta in OPCAB. METHODS: Forty-four patients scheduled for OPCAB were randomly allocated to receive gauze soaked with 10 ml of 4% lidocaine (n = 22) or normal saline (n = 22) on the side-clamping site of the aorta. Sodium nitroprusside (SNP) was infused as necessary to maintain the systolic blood pressure at around 100 mmHg immediately prior to and during side-clamp of the aorta. The requirement and frequency of use of SNP, as well as haemodynamic variables, were recorded serially. RESULTS: The number of patients requiring an SNP infusion and the average amount of infused SNP were significantly less in the lidocaine group. Systolic blood pressure increased significantly during side-clamping in the control group, but not in the lidocaine group. CONCLUSION: Topical application of lidocaine on the surface of the aorta is a simple and effective method to reduce the risk of a sudden increase in systemic blood pressure during side-clamping of the aorta.     

Atheroembolism from the ascending aorta. An emerging problem in cardiac surgery.

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.