Perioperative management
All patients underwent surgery using cardiopulmonary bypass. Near infrared spectrometry is used selectively: in patients undergoing major surgeries and patients known to have carotid atherosclerosis to guide intraoperative management. Epi-aortic ultrasound is not available at our centre for assessing the ascending aorta prior to aortic instrumentation and cannulation. Patients confirmed to have suffered a stroke were discussed with our local stroke physicians for ongoing management advice.