THE DIFFICULT PROXIMAL CORONARY ANASTOMOSIS

Area of Science:

• Cardiovascular Surgery
• Cardiac Surgery
• Aortic Surgery

Background:

• Severe calcific aortitis can complicate cardiac surgical procedures.
• Proximal coronary artery anastomosis is crucial for coronary artery bypass grafting (CABG).
• Calcific aortitis may render standard proximal anastomosis techniques impossible.

Purpose of the Study:

• To present innovative surgical strategies for performing proximal coronary anastomosis in patients with severe calcific aortitis.
• To demonstrate the feasibility of alternative techniques when standard CABG is precluded by aortic pathology.

Main Methods:

• Case report of two patients with severe calcific aortitis undergoing coronary artery bypass.
• Patient 1: Aortic endarterectomy of the ascending aorta post-aortic valve replacement, followed by aortocoronary bypass and proximal anastomosis.
• Patient 2: Resection of an anterior aortic segment, replacement with a Dacron patch, and subsequent sewing of vein grafts into the patch.

Main Results:

• Successful performance of proximal coronary anastomoses was achieved in both patients using modified techniques.
• The first patient underwent successful endarterectomy and bypass.
• The second patient had a successful aortic segment resection and patch angioplasty for graft anastomosis.

Conclusions:

• Surgical modification, including aortic endarterectomy or patch angioplasty, can overcome the challenges posed by severe calcific aortitis during CABG.
• These techniques offer viable solutions for achieving proximal coronary anastomoses in complex aortic conditions.
• Successful outcomes in these cases highlight the adaptability of surgical approaches in challenging cardiac scenarios.