[Coronary artery bypass graft for patients with ascending aorta atherosclerosis]
Bi-bo Yang1, Feng Gao, Zhong-qi Cui
1Department of Cardiac Surgery, Peking University Third Hospital, Beijing 100083, China.
Insights
Coronary artery bypass grafting (CABG) in patients with severe ascending aorta atherosclerosis can be safely performed using on-beating heart techniques or deep hypothermia with circulatory arrest to minimize aortic manipulation and complications.
Area of Science:
- Cardiovascular Surgery
- Atherosclerosis Research
- Surgical Risk Mitigation
Context:
- Elderly patients with severe ascending aorta atherosclerosis undergoing coronary artery bypass graft (CABG) surgery face significant risks.
- Traditional CABG techniques involving aortic cannulation and cross-clamping pose a high risk in these patients.
- Minimizing complications during CABG in patients with severe aortic atherosclerosis is a critical surgical challenge.
Purpose:
- To review surgical outcomes in 22 patients with severe ascending aorta atherosclerosis undergoing CABG.
- To identify and evaluate strategies for minimizing surgical complications in this high-risk patient group.
- To assess the efficacy of on-beating heart CABG and hypothermic circulatory arrest techniques.
Summary:
- Twenty-two patients with severe atherosclerotic ascending aorta underwent CABG using various techniques, including on-beating heart surgery and deep hypothermia with circulatory arrest.
- Five patients underwent proximal anastomosis on the ascending aorta using deep hypothermia and intermittent circulatory arrest, avoiding aortic cross-clamping or partial occlusion.
- The study reported a survival rate of 91% with no neurological complications or aortic dissection, though other complications like pneumonia and hemothorax were observed.
Impact:
- The findings suggest that CABG on a beating heart with arterial grafts is a preferred approach, avoiding direct manipulation of the diseased aorta.
- Deep hypothermia with circulatory arrest provides a bloodless field for proximal anastomosis without aortic clamping.
- Distal sequential and proximal "Y" type anastomoses are effective in minimizing manipulation of the diseased ascending aorta, thereby reducing surgical risks.
Objective:
The increasing number of aged patients with severe ascending aorta atherosclerosis who are undergoing coronary artery bypass graft (CABG) present high risk for ascending aortic cannulation, cross-clamping or partial occluding and proximal anastomosis. We reviewed the surgical experience in 22 patients of CABG with ascending aorta atherosclerosis and tried to find the way to minimize the complications.
Methods:
Twenty-two patients with severe atherosclerotic and calcified ascending aorta underwent CABG in our hospital. Thirteen of them received CABG on beating heart. Nine patients had their CABG with extracorporeal circulation. With deep hypothermia, we reduced the flow rate and intermittently arrested the circulation for the proximal anastomosis on ascending aorta in 5 patients with neither cross-clamping nor partial occluding. The sequential grafts and "Y" type anastomosis between reversed saphenous venous grafts were employed.
Results:
Twenty of the patients survived after surgery. One died of inhalation pneumonia in two weeks after surgery. Another died of right hemothorax in ten days after surgery. The complications include: pneumonia 4 patients (18%), angina 2 patients (9%), ventricular fibrillation 1 patients (5%), post-CABG myocardium infarction 1 case (5%) and hemothorax 1 case (5%). There is no neurologic complications or aortic dissection after CABG.
Conclusion:
CABG on beating heart with pedicel arterial grafts is the best approach to performing the surgery without touching the diseased ascending aorta. Ventricular fibrillation under mild hypothermia cardiopulmonary bypass and left ventricular suction were employed for quiet and bloodless field while distal anastomosis had no cross-clamping the ascending aorta. Also deep hypothermia and intermittently circulatory arrest offer quiet and bloodless field for the proximal anastomosis on ascending aorta without cross-clamping or partial-occluding. Distal sequential anastomosis and proximal "Y" type anastomosis are the effective approach to minimizing the proximal anastomosis on the ascending aorta.
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