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Coronary artery bypass grafting for patients with an atherosclerotic ascending aorta
1Department of Cardiovascular Surgery, Tenri Hospital, Tenri, Nara, Japan.
Insights
Coronary artery bypass grafting in patients with severe atherosclerotic ascending aorta had suboptimal outcomes. Advances in surgical techniques and atherosclerosis evaluation are needed to improve results.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
Background:
- Severe atherosclerotic ascending aorta poses significant risks during coronary artery bypass grafting (CABG).
- Traditional CABG techniques may be associated with increased morbidity and mortality in these high-risk patients.
Purpose of the Study:
- To review the outcomes of CABG in patients with severe atherosclerotic ascending aorta.
- To identify factors influencing surgical outcomes in this patient population.
Main Methods:
- Retrospective review of 31 patients undergoing CABG between 1990 and 1998.
- Assessment of ascending aortic lesions using epiaortic echo.
- Application of two aortic non-clamping techniques.
- Comparison of outcomes between hypothermic fibrillated heart, beating heart, and off-pump CABG.
Main Results:
- A 30-day mortality rate of 16.1% (5/31) was observed, with 4 deaths due to multiple emboli and 1 from perioperative myocardial infarction.
- One hospital death resulted from graft rupture, brain damage, and multiorgan failure.
- Actuarial survival was 73.0% at 3 years and 68.0% at 5 years.
- No late cardiac deaths occurred in the 25 survivors.
Conclusions:
- The outcomes of CABG in patients with severe atherosclerotic ascending aorta were suboptimal given the associated risks.
- Recent advancements in surgical techniques, including beating heart surgery and improved atherosclerosis assessment, hold promise for better outcomes.
Objectives:
We review the outcome of coronary artery bypass grafting in patients with a severe atherosclerotic ascending aorta.
Methods:
Subjects were 31 patients averaging 69.4 +/- 6.9 years old studied from 1990 through 1998. Ascending aortic lesions were assessed using epiaortic echo and 2 types of aortic nonclamping techniques applied. In 29 patients operated on in the early years, bypass grafting was conducted on the hypothermic fibrillated heart in 22 and on the beating heart in 7. The remaining 2 underwent off-pump coronary artery bypass grafting more recently. For cases with multivessel disease, we used composite grafting.
Results:
Three patients developed mild stroke and 5 died within 30 days of surgery--4 from multiple emboli (1 accompanied by a stroke) and 1 from perioperative myocardial infarction. One hospital death occurred due to brain damage and multiorgan failure following unexpected rupture of a saphenous vein graft. No cardiac deaths occurred in the late stage of our series. Actuarial survival was 73.0% for 3 years and 68.0% for 5 years. Freedom from cardiac events was favorable in the remaining 25 survivors.
Conclusions:
Outcome was suboptimal for the risks involved. Recent technical advances, including coronary surgery on the beating heart with or without cardiopulmonary bypass using variable in-situ or free arterial grafts, associated with adequate evaluation of systemic atherosclerosis, should improve this outcome.