Extra-anatomic coronary artery bypass graftings in patients with porcelain aorta
E Demirsoy1, M Unal, H Arbatli
1Department of Cardiovascular Surgery, Istanbul Memorial Hospital, Istanbul, Turkey. ergundemirsoy@hotmail.com, edemirsoy@superonline.com
Insights
Extra-anatomic coronary artery bypass grafting (CABG) offers a safe alternative for patients with porcelain ascending aorta. This approach minimizes the risk of stroke and systemic embolization during the procedure.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Cardiac Anesthesia
Background:
- Severely atherosclerotic (porcelain) ascending aorta poses significant risks during coronary artery bypass grafting (CABG).
- Potential complications include perioperative atheroembolism, leading to increased morbidity and mortality.
- Standard CABG maneuvers like aortic cannulation and clamping can dislodge atheromatous debris.
Purpose of the Study:
- To evaluate the safety and efficacy of extra-anatomic CABG in patients with porcelain ascending aorta.
- To assess the potential of this technique to reduce perioperative stroke and systemic embolization.
Main Methods:
- Extra-anatomic CABG was performed in 8 patients with heavily calcified ascending aortas.
- Arterial cannulation was achieved via the right femoral artery.
- Procedures included on-beating heart and fibrillating heart techniques with cardiopulmonary bypass (CPB).
Main Results:
- The postoperative course was uneventful for most patients.
- No patient experienced cerebrovascular or visceral organ injury due to atheroemboli.
- One patient with chronic renal failure died due to dialysis complications.
Conclusions:
- Extra-anatomic CABG is a safe and reliable strategy for patients with porcelain ascending aorta.
- This approach effectively minimizes the risk of perioperative stroke and systemic embolization.
- Consideration of alternative bypass strategies is crucial for high-risk patients.
Aim:
Severely atherosclerotic (porcelain) ascending aorta is associated with increased morbidity and mortality during coronary artery bypass grafting (CABG) due to the increased risk of perioperative atheroembolism. Three maneuvers during CABG can cause atheromatous embolism from the diseased ascending aorta: 1) cannulation of the ascending aorta; 2) cross- clamping; 3) partial clamping for the construction of the proximal anastomosis.
Methods:
In our hospital, extra-anatomic CABG was performed in 8 patients with heavily calcified ascending aorta: 6 patients were men and 2 women. Operations were performed on the beating heart in 5 patients, 2 patients operated on beating heart and another patient on fibrillating heart with supportive cardiopulmonary bypass (CPB). Arterial cannulation was done through the right femoral artery on these patients. Apart from internal mammary artery (IMA) grafts, proximal anastomotic sites were the right axillary, right subclavian and innominate arteries.
Results:
One patient who preoperatively had dialysis dependent chronic renal failure, died as a result of dialysis complication on the 5th day. The postoperative course was uneventful in the other patients and no patient experienced either any cerebrovascular or visceral organ injury as a result of atheroemboli.
Conclusion:
We think that extra-anatomic CABG procedures are safe and reliable in patients with severely atherosclerotic (porcelain) ascending aorta to minimize the prevalence of perioperative stroke and systemic embolization.
