A novel approach to coronary revascularization in patients with severely diseased aorta

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Vascular Surgery

Background:

• Atheromatous disease of the aorta increases risks during coronary revascularization procedures.
• Standard surgical approaches often require aortic manipulation, which can be hazardous in patients with severe aortic disease.
• Alternative strategies are needed to minimize perioperative complications in these high-risk patients.

Observation:

• This report details a novel surgical technique for coronary revascularization in patients with atheromatous aortas.
• The procedure utilizes bilateral internal thoracic arteries as composite grafts with reverse saphenous veins.
• Importantly, the operation is performed without cardiopulmonary bypass, avoiding aortic cannulation and cross-clamping.

Findings:

• Two patients with atheromatous aortas underwent this off-pump myocardial revascularization technique.
• Neither patient exhibited signs or symptoms of atheromatous embolization post-operatively.
• The procedure resulted in no perioperative morbidity or mortality for either patient.

Implications:

• Off-pump myocardial revascularization with bilateral internal thoracic arteries offers a safe and effective alternative for patients with atheromatous aortas.
• This approach is advantageous for patients who require avoidance of aortic manipulation, cannulation, cross-clamping, and cardiopulmonary bypass.
• The technique represents a significant advancement in managing complex coronary artery disease in the presence of severe aortic pathology.