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[Evaluation of calcified ascending aorta by thoracic computed tomography and technical pitfall for coronary artery
K Takasawa1, K Fuse, T Konishi
1Toranomon Hospital, Cardiovascular Center.
Insights
Preoperative computed tomography (CT) effectively identifies ascending aorta calcification in coronary bypass patients. Modified surgical techniques in these high-risk cases successfully prevented embolic events, reducing stroke risk.
Area of Science:
- Cardiovascular Surgery
- Diagnostic Imaging
- Vascular Medicine
Background:
- Ascending aorta calcification poses a significant risk for embolic events during coronary artery bypass grafting (CABG).
- Preoperative assessment of aortic calcification is crucial for surgical planning and patient safety.
Purpose of the Study:
- To evaluate the effectiveness of computed tomography (CT) in identifying ascending aorta calcification before CABG.
- To assess the safety and efficacy of modified surgical approaches in patients with severe aortic calcification.
Main Methods:
- Retrospective analysis of 94 coronary bypass patients.
- Preoperative computed tomography (CT) for assessing ascending aorta calcification.
- Documentation of surgical modifications including femoral cannulation, distal anastomosis without aortic cross-clamp, single aortic cross-clamp for proximal anastomosis, and use of arterial conduits.
Main Results:
- Computed tomography (CT) detected ascending aorta calcification in 12.8% (12 out of 94) of patients.
- In patients with severe calcification, various surgical modifications were employed.
- No embolic episodes were observed in this series, indicating successful stroke prevention.
Conclusions:
- Thoracic computed tomography (CT) is a valuable tool for preoperative evaluation of ascending aorta calcification.
- Surgical modifications in patients with calcified ascending aorta are necessary to prevent stroke.
- Modified surgical strategies can mitigate embolic risks in CABG patients with severe aortic calcification.
Abstract:
The cumulative 94 coronary bypass patients were evaluated on calcification of the ascending aorta preoperatively by computed tomography (CT). CT demonstrated the calcification of the ascending aorta in 12 patients (12.8%). In these patients with severely calcified ascending aorta, we performed femoral cannulation (6 cases), distal anastomosis without aortic cross clamp (2 cases), proximal anastomosis through single aortic cross clamp (3 cases) and non proximal anastomosis to use arterial conduits (3 cases). In this series, we did not have any embolic episode. The thoracic computed tomography is effective for evaluation of calcified ascending aorta and in this situation, operative modifications are necessary for obviation of stroke.