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[Technical problems during coronary revascularization in case of massive calcified aorta]
G Popoff1, F Diaz, P Kreitmann
1Service de chirurgie cardiaque, Institut Arnault-Tzanck, Saint-Laurent-du-Var.
Archives Des Maladies Du Coeur Et Des Vaisseaux
|April 1, 1992
Summary
Massively calcified aortas pose challenges for coronary revascularization surgery. This study demonstrates successful complete revascularization in two patients using modified techniques, avoiding aortic clamping.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Massively calcified ascending aorta presents a significant surgical challenge for coronary revascularization.
- Aortic clamping, a standard procedure, may be impossible in such cases, necessitating alternative approaches.
Observation:
- Two patients with severely calcified ascending aortas underwent complete revascularization.
- Arterial cannulation sites included the aortic arch, brachiocephalic artery, and common femoral artery.
- The ascending aorta was not clamped or used for graft origin in either case.
Findings:
- Myocardial protection was achieved through systemic cooling and ventricular fibrillation without cardioplegia.
- Both patients experienced good surgical outcomes, confirmed by angiography.
- The study successfully demonstrated complete revascularization in multivessel disease despite aortic calcification.
Implications:
- The findings suggest feasibility of modified techniques for patients with extreme aortic calcification.
- A proposed peroperative palpation-based classification could guide the use of these modifications.
- These techniques may benefit patients with severe atherosclerosis and high neurological risk, without precluding classical methods.