Adverse cerebral outcomes after coronary bypass surgery.

To the Editor: In their prospective, multi-institutional study of adverse cerebral outcomes after coronary-artery bypass surgery, Roach et al. (Dec. 19 issue)1 have documented the frequency of such outcomes (6.1 percent) and their costs in terms of increases in mortality, length of hospital stay, and care after hospital discharge. It is becoming increasingly evident that atherosclerosis of the ascending aorta is one of the most important predictors, if not the most important predictor, of what the authors termed a type I outcome. Two studies, among others, have documented the importance of aortic atherosclerosis and the use of epiaortic ultrasonography or transesophageal echocardiography for its detection.2,3 Two studies involved over 1200 patients each,2,4 and one was prospective.2 These studies have established that visual inspection and palpation of the ascending aorta underestimate the frequency and severity of atherosclerosis.2,3