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The heavily calcified aorta and re-do CABG surgery: technical considerations how to avoid aortic crossclamp.
Ferdinand Kuhn-Régnier1, Hans J Geissler, Uwe Mehlhorn
1Department of Cardiothoracic Surgery, University of Cologne, Joseph-Stelzmannstr 9, 50924, Cologne, Germany. Ferdinand.Kuhn-Regnier@medizin.unikoeln.de
Insights
Abandoning aortic crossclamping during re-do CABG surgery can reduce risks in patients with aortic calcification. Intra-aortic esmolol provides myocardial protection and surgical exposure without aortic crossclamp.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Background:
- Aortic crossclamping poses risks like acute aortic dissection and embolic stroke, especially in patients with severe aortic calcification.
- Re-operative coronary artery bypass grafting (CABG) involves extensive dissection of adhesions, increasing risks to great vessels and grafts.
Purpose of the Study:
- To evaluate the advantages of abandoning aortic crossclamping in patients undergoing re-do CABG or those with aortic calcification.
- To explore methods for achieving myocardial protection and surgical exposure without aortic crossclamping.
Main Methods:
- Investigated strategies to minimize aortic manipulation during re-do CABG.
- Considered intra-aortic administration of esmolol, a short-acting beta-blocker, for myocardial protection and surgical access.
Main Results:
- Abandoning aortic crossclamping may reduce the risk of aortic injury and embolic events in specific patient populations.
- Intra-aortic esmolol can facilitate myocardial protection and surgical exposure, obviating the need for aortic crossclamping.
Conclusions:
- Minimizing aortic manipulation by abandoning aortic crossclamping is beneficial for patients with severe aortic calcification or undergoing re-do CABG.
- Intra-aortic esmolol offers a viable alternative for myocardial protection and surgical exposure, enhancing safety in these procedures.
Abstract:
Aortic crossclamp may increase the risk for acute aortic dissection and embolic stroke in patients with severe aortic calcification. Additionally, in CABG re-operation aortic crossclamp may necessitate extensive dissection of fibrous adhesions which may intensify the potential risk of injury to the aorta, pulmonary artery or patent bypass grafts. Therefore, it appears to be advantageous in patients undergoing re-do CABG or with aortic calcification to minimize surgical manipulation of the aorta by abandonment of aortic crossclamp. Adequate myocardial protection and convenient surgical exposure without aortic crossclamp max be achieved by intraaortic administration of the short acting ss-blocker esmolol.