Treatment of anomalous arterial supply to the basal segment of left lung with aortic stent graft.

The patient was a 53-year-old man with a history of recurrent sputum. An anomalous systemic arterial supply to the basal segment of the left lung with an aneurysm of the aberrant artery detected on three-dimensional computed tomography angiography. Before left lower pulmonary lobectomy and aberrant artery resection, thoracic endovascular aortic repair was performed to block the blood flow to the aberrant artery aneurysm. Prior blockade of the blood flow to the aneurysm minimized the risk of aneurysm rupture and bleeding during lobectomy, yielding a good postoperative outcome.

Case of a lung collision tumor consisting of squamous cell carcinoma of the lung and diffuse large B-cell lymphoma.

Among the reports of malignant collision tumors, collision tumors consisting of lung cancer and malignant lymphoma are extremely rare. We report case of a lung collision tumor consisting of squamous cell carcinoma of the lung and diffuse large B-cell lymphoma.

Pulmonary valve myxoma requiring pulmonary valve replacement: a case report.

BACKGROUND: Most cardiac myxomas occur in the atria. Myxomas arising from the heart valves are rare, and there are only a few reports of myxomas arising from the pulmonary valve. Complete resection and prevention of embolization at the time of the first surgery are important to prevent the recurrence of myxomas. CASE PRESENTATION: An 82-year-old female was scheduled to undergo surgery for a fracture of the right femoral neck. The preoperative echocardiography showed a mass in the right ventricular outflow tract. The mass was 36 × 30 mm in size and entered into the pulmonary artery during systole. Cardiac synchronous computed tomography showed a stalked bifurcated mass near the pulmonary valve, which was suspected to be a myxoma. Surgical findings showed a lumen-occupying tumor when the main pulmonary artery was incised. Since the tumor was a single mass with a stalk on the pulmonary valve (right and left pulmonary valve cusps), tumor resection and pulmonary valve replacement (bioprosthetic valve) were performed. A right prosthetic femoral head insertion was performed on postoperative day 36, and the patient was transferred to the hospital on postoperative day 44. However, 1 year later, the patient developed a large myxoma (recurrence) that completely occluded the right pulmonary artery and died of right heart failure. CONCLUSIONS: We report the case of a patient with a very rare myxoma arising from the pulmonary valve, which was treated with tumor resection and pulmonary valve replacement surgery; however, the patient developed another myxoma 12 months later and this tumor was larger than the primary tumor. The surgical margins were indistinct, and there was a high possibility of residual tumor in the pulmonary artery wall; hence, an extended resection should have been considered. The recurrence of myxoma, in this case, suggests that it is important to completely resect the primary tumor during the first surgery and to prevent intraoperative embolization.

Geometrical and electrophysiological data of the moving membrane method for the osmotic water permeability of a lipid bilayer.

Data of the osmotic water permeability of a lipid bilayer (diphytanoylphosphaticylcholin) in the presence of cholesterol (30 mole%) are shown under the simultaneous measurement of bilayer tension. Detailed methods and procedures for evaluating the water permeability using the moving membrane method (K. Yano, M. Iwamoto, T. Koshiji & S. Oiki: Visualizing the Osmotic Water Permeability of a Lipid Bilayer under Measured Bilayer Tension Using a Moving Membrane Method. Journal of Membrane Science, 627 (2021) 119231) are presented. The planar lipid bilayer is formed in a glass capillary, separating two aqueous compartments with different osmolarities, and osmotically-driven water flux is visualized as membrane movements along the capillary. The water permeability was evaluated under constant membrane area and tension after correcting for the unstirred layer effect. In these measurements, geometrical features, such as the edge of the planar lipid bilayer and the contact angle between bilayer and monolayer, were image-analyzed. The unstirred layer was evaluated electrophysiologically, in which gramicidin A channel was employed. In the presence of an osmotic gradient, the gramicidin channel generates the streaming potential, and the measured streaming potential data and the derived water-ion coupling ratio (water flux/ion flux) are shown. Detailed descriptions of the integrated method of the moving membrane allow researchers to reproduce the experiment and give opportunities to examine water permeability of various types of membranes, including those containing aquaporins. The present data of osmotic water permeability are compared with the previously published data, while they neglected the bilayer tension.

Intratumoral gene expression of dihydrofolate reductase and folylpoly-c-glutamate synthetase affects the sensitivity to 5-fluorouracil in non-small cell lung cancer.

BACKGROUND: Various factors related to the sensitivity of non-small cell lung carcinoma (NSCLC) to 5-fluorouracil (5-FU) have been reported, and some of them have been clinically applied. In this single-institutional prospective analysis, the mRNA expression level of five folic acid-associated enzymes was evaluated in surgical specimens of NSCLC. We investigated the correlation between the antitumor effect of 5-FU in NSCLC using an anticancer drug sensitivity test and the gene expression levels of five enzymes. MATERIALS AND METHODS: Forty patients who underwent surgery for NSCLC were enrolled, and the antitumor effect was measured using an in vitro anticancer drug sensitivity test (histoculture drug response assay) using freshly resected specimens. In the same sample, the mRNA expression levels of five enzymes involved in the sensitivity to 5-FU were measured in the tumor using real-time PCR. The expression levels and the result of the sensitivity test were compared. RESULTS: No correlation was found between dihydropyrimidine dehydrogenase (DPD), orotate phosphoribosyltransferase (OPRT), or DPD/OPRT expression and the antitumor effects of 5-FU. On the other hand, a correlation was found between thymidylate synthase (TS), folylpoly-c-glutamate synthetase (FPGS), and dihydrofolate reductase (DHFR) expression and 5-FU sensitivity. CONCLUSION: Expression of FPGS and DHFR may be useful for predicting the efficacy of 5-FU-based chemotherapy for NSCLC.

Clinical efficacy of thrombus aspiration on 5-year clinical outcomes in patients with ST-segment elevation acute myocardial infarction undergoing percutaneous coronary intervention.

BACKGROUND: Adjunctive thrombus aspiration (TA) during primary percutaneous coronary intervention (PCI) was reported to promote better coronary and myocardial reperfusion. However, long-term mortality benefit of TA remains controversial. The objective of this study is to investigate the clinical impact of TA on long-term clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary PCI. METHODS AND RESULTS: The CREDO-Kyoto AMI Registry is a large-scale cohort study of acute myocardial infarction patients undergoing coronary revascularization in 2005-2007 at 26 hospitals in Japan. Among 5429 patients enrolled in the registry, the current study population consisted of 3536 patients who arrived at the hospital within 12 hours after the symptom onset and underwent primary PCI. Clinical outcomes were compared between the 2 patient groups with or without TA. During primary PCI procedures, 2239 out of 3536 (63%) patients underwent TA (TA group). The cumulative 5-year incidence of all-cause death was significantly lower in the TA group than in the non-TA group (18.5% versus 23.9%, log-rank P<0.001). After adjusting for confounders, however, the risk for all-cause death in the TA group was not significantly lower than that in the non-TA group (hazard ratio: 0.90, 95% CI: 0.76 to 1.06, P=0.21). The adjusted risks for cardiac death, myocardial infarction, stroke, and target-lesion revascularization were also not significantly different between the 2 groups. CONCLUSIONS: Adjunctive TA during primary PCI was not associated with better 5-year mortality in STEMI patients.

Hemorrhage as a life-threatening complication after valve replacement in end-stage renal disease patients.

OBJECTIVE: Hemodialysis patients have an increased risk of hemorrhage compared to other patients. This study reports the frequencies of hemorrhage and its impact on the survival of hemodialysis patients after valve replacement. METHODS: A total of 77 consecutive dialysis patients who underwent prosthetic valve surgery from 1991 to 2011 were retrospectively reviewed. Their mean age was 65.8 ± 9.2 years. Forty-three patients (56%) were male. Fifty-nine patients (77%) had aortic valve replacement, and 23 patients (30%) had mitral valve replacement. Bioprosthetic valves were used in 17 patients (22%). RESULTS: There were seven in-hospital mortalities (9.1%). The overall estimated Kaplan-Meier survival after 3, 5 and 7 years was 66.6 ± 5.6, 51.1 ± 6.3 and 34.4 ± 6.8%, respectively. Seventeen (22%) bleeding events were observed (5.9% per patient-years) in the follow-up period. Six of the nine patients with cerebral hemorrhages and two of the six with gastrointestinal hemorrhages died. There were no differences in the frequencies of hemorrhage between the patients treated with bioprostheses and mechanical valves. CONCLUSIONS: This study found that 22% of dialysis patients had hemorrhagic events after valve replacement, and approximately half of them died. Particularly, cerebral hemorrhage was fatal and two thirds of the patients died. So we should meditate the methods to reduce hemorrhage. Therefore, new methods to reduce the risk of hemorrhage are urgently needed.

Controlling air leaks using free pericardial fat pads as surgical sealant in pulmonary resection.

BACKGROUND: This study evaluated the feasibility and efficacy of a new operative method for controlling intraoperative air leaks using free pericardial fat pads as a covering sealant in pulmonary resection. METHODS: To manage air leaks that must be controlled in pulmonary resection at the first water sealing test, collected free pericardial fat was used as a covering sealant and sewn on by the suture closing the lesion. In cases of uncontrolled air leaks at the second sealing test, fibrin glue was used to fill the residual lesion between the fat and visceral pleura. Fifty-one eligible patients were enrolled in this study to evaluate the duration of postoperative air leaks and the condition of the implanted fat on chest computed tomography (CT) 6 months later. RESULTS: The mean duration of postoperative air leaks was 1.05 ± 1.84 days in the 39 cases that received the pericardial fat covering technique only and 2.66 ± 3.42 days in the 12 cases that received the pericardial fat covering technique combined with fibrin glue. Prolonged alveolar air leaks occurred in 1 case and 2 cases, respectively. No cases required conversion to conventional methods, and there were no further adverse events. On follow-up chest CT approximately 62.7% of obvious engrafted fat survived. CONCLUSIONS: Using free pericardial fat pads as a sealant to control air leaks in pulmonary resection is safe and has good feasibility and potent efficacy. This new method can be an innovative technique for preventing prolonged air leaks.

Renal redox dysregulation in AKI: application for oxidative stress marker of AKI.

Oxidative stress is a major determinant of acute kidney injury (AKI); however, the effects of an AKI on renal redox system are unclear, and few existing AKI markers are suitable for evaluating oxidative stress. We measured urinary levels of the redox-regulatory protein thioredoxin 1 (TRX1) in patients with various kinds of kidney disease and in mice with renal ischemia-reperfusion injury. Urinary TRX1 levels were markedly higher in patients with AKI than in those with chronic kidney disease or in healthy subjects. In a receiver operating characteristic curve analysis to differentiate between AKI and other renal diseases, the area under the curve for urinary TRX1 was 0.94 (95% confidence interval, 0.90-0.98), and the sensitivity and specificity were 0.88 and 0.88, respectively, at the optimal cutoff value of 43.0 µg/g creatinine. Immunostaining revealed TRX1 to be diffusely distributed in the tubules of normal kidneys, but to be shifted to the brush borders or urinary lumen in injured tubules in both mice and humans with AKI. Urinary TRX1 in AKI was predominantly in the oxidized form. In cultured human proximal tubular epithelial cells, hydrogen peroxide specifically and dose dependently increased TRX1 levels in the culture supernatant, while reducing intracellular levels. These findings suggest that urinary TRX1 is an oxidative stress-specific biomarker useful for distinguishing AKI from chronic kidney disease and healthy kidneys.

Bilateral internal thoracic artery grafting for peripheral arterial disease patients.

BACKGROUND: Peripheral arterial disease (PAD) is known to have a poor prognosis. Some reports have also described poor late results after coronary artery bypass grafting (CABG). However, there have been few reports about whether bilateral internal thoracic artery grafting improves the long-term survival of PAD patients after CABG. We performed this study to clarify whether or not this is the case. METHODS: One hundred and thirty-six PAD patients who underwent elective CABG with two or more grafts were enrolled in this study. Patients were divided into two groups, 71 patients in the bilateral internal thoracic artery (BITA) group and 65 patients in the single internal thoracic artery (SITA) group. The maximum follow-up period was 19 years, with a mean of 5.7 ± 4.4 years. RESULTS: We investigated the long-term results based on three factors; survival, freedom from cardiac death, and freedom from cardiac events. The 3-, 5- and 10-year survival rates in the BITA group were 83.0, 74.2, and 43.1%, respectively. And those in the SITA group were 79.4, 67.7, and 32.3%, respectively. There were no significant differences between the two groups (p = 0.5843). There were also no statistically significant differences between the two groups in terms of the freedom from cardiac death (p = 0.8589) or in the freedom from cardiac events (p = 0.9445). CONCLUSION: No long-term advantage was observed for CABG with BITA in comparison to SITA alone in patients with PAD.

Impact of polyvascular disease on clinical outcomes in patients undergoing coronary revascularization: an observation from the CREDO-Kyoto Registry Cohort-2.

OBJECTIVE: Patients with coronary artery disease (CAD) often have prior stroke or concomitant extra-cardiac vascular disease (EVD) such as cerebral, aortic, or peripheral vascular disease. However, clinical outcomes after coronary revascularization in patients with polyvascular disease have not been fully elucidated. METHODS: Among 15,263 patients undergoing first coronary revascularization enrolled in the CREDO-Kyoto registry Cohort-2 from January 2005 to December 2007, there were 1443 patients with prior stroke (stroke + CAD group), 974 patients with EVD (EVD + CAD group), 253 patients with both prior stroke and EVD (stroke/EVD/CAD group) and 12,593 patients with neither prior stroke nor EVD (CAD alone group [reference]). RESULTS: The cumulative incidence of major adverse cardiovascular events (MACE: composite of cardiovascular death, myocardial infarction and stroke) through 3 years was significantly higher in patients with polyvascular disease compared with reference patients (19.9% in the stroke + CAD group, 18.5% in the EVD + CAD group, 20.1% in the stroke/EVD/CAD group, and 11.2% in the CAD alone group, P < 0.0001). After adjusting confounders, the presence of EVD and/or stroke was independently associated with higher risk for MACE compared with the reference group (adjusted HR [95%CI]: 1.34 [1.17-1.54], P < 0.0001 in the stroke + CAD group, 1.56 [1.32-1.84], P < 0.0001 in the EVD + CAD group, and 1.66 [1.24-2.23], P = 0.0007 in the stroke/EVD/CAD group). However, the presence of EVD and/or stroke was not associated with higher risk for myocardial infarction. CONCLUSIONS: Clinical outcome after coronary revascularization was worse in patients with prior stroke and/or EVD, which was mainly driven by the increased risk for non-coronary cardiovascular events.

An effective method of pleurodesis involving absorbable mesh for repetitive catamenial pneumothorax.

Catamenial pneumothorax (CPX) is an aetiologically very complex disease for which the treatments for pneumothorax and endometriosis are generally adapted. However, emphasizing secondary prevention, we developed a new method. This powerful new technique for prevention of pneumothorax during menstruation by surgical pleurodesis using absorbable mesh is presented. CPX is a relatively rare disease characterized by recurrent pneumothorax during menstruation. Although pathological diagnosis is desirable, CPX is clinically defined as recurrent pneumothorax synchronized with the menstrual cycle. Unfortunately, conventional therapy, including hormonal treatment and surgical procedures, seems to be associated with a high rate of recurrence; there is no well-established treatment for CPX. Recently, we developed a useful and effective operative method for spontaneous pneumothorax, with which one can remove the lesion site and sew a polyglactin mesh on the lung concurrently by endoscopic linear cutter under video-assisted thoracoscopic surgery, dressing the lung with polyglactin mesh to reinforce the stump and facilitating pleural adhesion for secondary prevention. We have used this method to resect pathological lung lesions and promote pleurodesis to prevent recurrence. In addition, polyglycolate felt was placed to cover the lesion site in the diaphragm in four cases of repetitive and treatment-resistant CPX as surgical pleurodesis, and successful results were obtained.

Pulmonary artery obstruction due to a metastatic malignant phyllodes tumor of the breast.

A 65-year-old woman with a 9-year surgical history of a left breast phyllodes tumor was admitted with progressive chest pain on effort. Computed tomography showed severe stenosis of the main pulmonary artery, with the mass originating from the ventricular septum. We planned to resect the tumor the next day. However, the next morning a pulmonary artery embolism occurred, and she developed dyspnea and lost consciousness. After carrying out cardiopulmonary resuscitation, we performed a life-saving operation. We successfully resected the huge tumor as far as possible from the right ventricle via a right atrial (RA)-tomy. However, her consciousness did not improve to better than Glasgow Coma Scale grade 7. She died from suffocation caused by metastasis invading her airway despite undergoing tracheotomy on the 77 th postoperative day.

Novel wrapping technique with insertion of fat tissue for hemostasis in aortic surgery.

The standard techniques and prosthetic materials for graft replacement in aortic surgery have been dramatically improved. However, persistent oozing and bleeding during aortic surgery sometimes occur and lead to life-threatening problems because of severe coagulopathy, which results from induced hypothermia, long cardiopulmonary bypass time, or fragile aortic walls by acute aortic dissection. Although various techniques and devices for reduction of bleeding have been already documented, these techniques are not always perfect and are sometimes complex. A new wrapping technique with insertion of fat tissue, as described in this report, is simple and provides a perfect hemostasis.

Abnormalities in the brain before elective cardiac surgery detected by diffusion-weighted magnetic resonance imaging.

BACKGROUND: Diffusion-weighted magnetic resonance imaging (DWI) has found ischemic lesions in the brain after cardiac surgery. However, preoperative cerebral injury has not been studied closely. In this study, we used DWI to assess the prevalence of abnormalities in patients scheduled for cardiac surgery. METHODS: We used conventional magnetic resonance imaging and DWI to study 247 consecutive patients scheduled for elective cardiac surgery. Clinical characteristics, neuropsychological test performance, and radiographic data were collected and compared with a group of patients who had normal findings on DWI. RESULTS: Eleven of the 247 patients (4.5%) had cerebral ischemic lesions on DWI before surgery. Compared with patients who had normal findings on DWI, patients who had abnormalities had significantly higher rates of history of cerebrovascular disease (64% versus 12%), cardiac catheterization within 14 days before DWI (91% versus 54%), preoperative cerebral infarctions (45% versus 5%), carotid artery stenosis (36% versus 5%), and preoperative cognitive impairment (55% versus 9%). Of the 11 patients with DWI abnormalities, 5 had delayed elective surgery and follow-up image studies; of these 5, 4 showed no relevant ischemic lesion on preoperative follow-up imaging. Among the other 6 patients, 1 had an infarction due to expansion of the same lesion that was detected on the preoperative DWI. There was no significant difference with regard to the incidence of postoperative stroke and cognitive dysfunction. CONCLUSIONS: In all, 4.5% of cardiac surgery patients had existing cerebral ischemic lesions on DWI without obvious neurologic defects. Further studies are required to determine whether the lesions are associated with postoperative cognitive dysfunction or stroke.

Early neuropsychological dysfunction in elderly high-risk patients after on-pump and off-pump coronary bypass surgery.

PURPOSE: Advanced age is associated with systemic atherosclerosis and is a risk factor for neurological dysfunction after coronary artery bypass grafting (CABG). However, few studies have investigated early neurological dysfunction after off-pump CABG in elderly patients. METHODS: Data were collected prospectively on 218 patients (>/=60 years) who underwent elective off-pump (n = 89) or on-pump CABG (n = 129). Four cognitive tests were performed preoperatively and 1 week postoperatively. Neuropsychological (NP) dysfunction was defined as a decrease in an individual's performance in more than two tests of at least 20% from baseline. We compared the incidence of NP dysfunction, stroke, graft patency grading, and systemic atherosclerosis between patients who underwent off-pump and on-pump CABG. RESULTS: Off-pump patients were more likely to have a history of cerebrovascular disease, peripheral vascular disease, smoking, multiple cerebral infarctions, and severe aortic atherosclerosis. None of the off-pump and three on-pump patients suffered intraoperative strokes (P = 0.27). The incidence of NP dysfunction was 11.2% in the off-pump group and 22.5% in the on-pump group, (P = 0.02). Multivariate analysis revealed that NP dysfunction was associated with cardiopulmonary bypass (CPB) and multiple cerebral infarctions. The off-pump group had fewer vessels grafted (2.4 vs 3.4; P < 0.01), and a higher rate of stenosis (>50%) and occlusion of the grafted vessels (13.0% vs 7.4%; P = 0.01) than the on-pump group. CONCLUSION: Off-pump CABG reduced postoperative NP dysfunction in elderly patients with severe systemic atherosclerosis compared to on-pump CABG.

Gender differences in stroke risk among the elderly after coronary artery surgery.

BACKGROUND: Previous studies have shown that women are at higher risk than men for stroke after coronary artery bypass graft (CABG) surgery, but gender differences in systemic atherosclerosis have not been studied adequately. We investigated gender differences in the incidence of craniocervical and ascending aortic atherosclerosis and other risk factors for stroke in elderly patients (age > or =60 yr) undergoing CABG surgery. METHODS: Data were prospectively collected on 720 patients (31.8% women) undergoing CABG surgery. All patients underwent preoperative brain magnetic resonance imaging and angiography to assess for prior cerebral infarctions, carotid artery stenosis, and intracranial arterial stenosis. Epiaortic ultrasound was performed at the time of surgery to assess for atherosclerosis of the ascending aorta. Cognitive status was measured using the Hasegawa-dementia score in all patients before surgery and on the seventh postoperative day. RESULTS: Women were older and had more hypertension and intracranial arterial stenosis than did men. Men had significantly higher rates of hyperlipidemia, peripheral vascular disease, abdominal aortic aneurysm, smoking history, severe carotid artery stenosis, and severe aortic atherosclerosis than did women. Although there were no differences in prior cerebral infarction or preoperative cognitive impairment, the rate of perioperative stroke was marginally higher in men than in women (3.9% vs 1.3%, P = 0.066). Univariate predictors of perioperative stroke were prior cerebral infarctions, ascending aortic atherosclerosis, preexisting cognitive impairment, and peripheral vascular disease. Stepwise logistic regression analysis demonstrated that significant independent predictors of perioperative stroke were prior cerebral infarctions and aortic atherosclerosis. CONCLUSIONS: These data suggest that men are more likely than women to have risk factors for stroke, including severe carotid artery stenosis, severe aortic atherosclerosis, and peripheral vascular disease. The rates of prior cerebral infarction and preoperative cognitive impairment were similar between genders.

Gastroepiploic artery grafting does not improve the late outcome in patients with bilateral internal thoracic artery grafting.

BACKGROUND: Bilateral internal thoracic artery grafting in coronary artery bypass surgery has a better long-term outcome than single internal thoracic artery grafting. However, the efficacy of gastroepiploic artery (GEA) grafting in addition to bilateral internal thoracic artery grafting is still not well-established. METHODS: From 1989 to 1999, 311 patients underwent coronary artery bypass grafting using in situ bilateral internal thoracic arteries anastomosed to the left coronary arteries and either an in situ GEA or a saphenous vein graft (SVG) anastomosed to the right coronary artery. Ninety-nine patients using the in situ GEA (GEA group) were compared with 212 patients using the SVG (SVG group) anastomsed to the right coronary artery. Young patients and patients with hyperlipidemia were more prevalent in the GEA group. RESULTS: The seven-year survival rate in the GEA group and the SVG group were 94.7% and 87.2%, respectively (p = 0.068). In a multivariate analysis, the age, renal failure, and a low ejection fraction (<0.40) were all significant predictors of survival. The GEA was not a significant predictor. The seven-year freedom rates from cardiac events were similar in both groups (GEA group, 76.5%; SVG group, 78.6%; p = 0.455). The seven-year freedom rates from recurrent angina were also similar between the groups (GEA group, 85.3%; SVG group, 88.8%; p = 0.700). CONCLUSIONS: In comparison with SVG grafting, GEA grafting to the right coronary artery did not significantly improve the late outcomes in patients with bilateral internal thoracic artery grafting.

Aortic atherosclerosis and postoperative neurological dysfunction in elderly coronary surgical patients.

BACKGROUND: Arteriosclerosis of the ascending aorta is an important risk factor for cerebral embolism. However, the association between arteriosclerosis of the ascending aorta and neurologic dysfunction after coronary artery surgery has not been evaluated prospectively. METHODS: We examined whether varying degrees of arteriosclerosis in the ascending aorta, assessed by epiaortic ultrasonography, increased the incidence of neuropsychologic dysfunction and stroke in 463 elderly patients (> or = 60 years old) after coronary artery surgery. RESULTS: Patients with severe arteriosclerosis (n = 76) had higher rates of postoperative neuropsychologic dysfunction (26%) and intraoperative stroke (10.5%); the moderately atherosclerotic patients (n = 57) had rates of 7% and 1.8%, respectively; whereas control patients (almost normal or mild arteriosclerosis, n = 330) had rates of 8% and 1.2%, respectively (all p < 0.001). Univariate analysis indicated that multiple small infarctions or broad infarctions, cerebral arterial stenosis, circulatory arrest, maximal thickness of intima around the site of aortic manipulation, and deformities due to clamp or cannulation were associated significantly with intraoperative strokes in patients with severe arteriosclerosis. CONCLUSIONS: Severe arteriosclerosis of the ascending aorta significantly increased the risk of postoperative neuropsychologic dysfunction and stroke after coronary artery bypass grafting. If a thick plaque is noted near the manipulation site, a nontouch method of the ascending aorta should be applied to reduce the incidence of neurologic dysfunction.