Coronary-coronary bypass using vein graft on a beating heart in a patient with porcelain aorta

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Cardiac Anesthesia

Background:

• Severely atherosclerotic ascending aorta, termed "porcelain aorta," poses a significant risk of systemic embolism during cardiopulmonary bypass.
• Traditional cardiopulmonary bypass (CPB) necessitates aortic manipulation, increasing embolic event risk in porcelain aorta patients.

Observation:

• A 74-year-old male patient with a porcelain aorta underwent coronary artery bypass grafting.
• The procedure involved off-pump coronary artery bypass (OPCAB) using a saphenous vein graft and a left internal mammary artery graft.
• The surgery was performed on a beating heart, avoiding CPB.

Findings:

• The patient experienced no perioperative myocardial infarction or cerebrovascular accident.
• One-year follow-up angiography confirmed excellent graft patency and distal run-off.
• The OPCAB technique proved to be a safe and effective revascularization strategy for this high-risk patient.

Implications:

• Off-pump coronary artery bypass grafting is a viable and safe alternative for patients with porcelain aorta, mitigating embolic risks.
• This approach expands treatment options for complex coronary artery disease in patients with severe aortic atherosclerosis.
• Further studies are warranted to evaluate long-term outcomes and broader applicability of OPCAB in porcelain aorta patients.