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Aortic plaque distribution in relation to cross clamp and cannulation procedures during cardiac surgery
Patrik Boivie1, Magnus Hansson, Karl Gunnar Engström
1Department of Surgical and Perioperative Sciences, Umeå University Hospital, Umeå, S-901 85, Sweden. patrik.boivie@vll.se
Insights
Aortic atherosclerosis is common and age-dependent. Cardiac surgery carries a 46% risk of plaque interference during cannulation or clamping, highlighting the need for pre-operative imaging.
Area of Science:
- Cardiovascular Surgery
- Vascular Biology
- Atherosclerosis Research
Background:
- Aortic atherosclerosis is a known risk factor for cerebrovascular accidents during cardiac surgery.
- Understanding plaque distribution is crucial for mitigating surgical risks.
Purpose of the Study:
- To analyze aortic plaque distribution in relation to potential surgical manipulation during cardiac procedures.
- To assess the risk of plaque interference during aortic cannulation and cross-clamping.
Main Methods:
- Digital macro-anatomic mapping of plaques in the thoracic aorta of 24 autopsy subjects.
- Comparison of plaque density across different aortic segments.
- Blind analysis of surgical manipulation hazards by superimposing cannulation and cross-clamp sites on plaque maps.
Main Results:
- Atherosclerotic plaques were frequently observed and correlated with age.
- The anterior wall of the ascending/arch aorta showed higher plaque density than the posterior wall (p=0.039).
- A 46% theoretical risk of plaque interference was identified during blind cannulation and/or cross-clamp positioning.
Conclusions:
- Plaque formation in the aorta is a frequent, age-related issue.
- While anterior aortic walls have higher plaque density, anterior and posterior plaques often coexist.
- Blind surgical maneuvers pose a significant risk of plaque interference, underscoring the importance of epiaortic scanning.
Objective:
Aortic atherosclerosis may cause cerebrovascular accidents in cardiac surgery. Aortic plaque distribution was analyzed in relation to surgical manipulation.
Design:
In 24 autopsy subjects the thoracic aorta was digitally analyzed by macro-anatomic mapping of plaques. Plaque density was compared in different anatomical segments. Hazards associated with surgical manipulation were blindly studied by superimposing cannulation and cross-clamp locations onto the maps.
Results:
Plaques were frequent. The anterior wall of the ascending/arch aorta had higher plaque density than its posterior side (p=0.039). However, an anterior plaque predicted to 83% a concomitant plaque in the posterior wall. Plaque formation correlated with age (p=0.004). The theoretical risk of interfering with a plaque during cannulation and/or clamp positioning was 46%.
Conclusions:
Plaque formation is a frequent and age-dependent problem. In the surgery-exposed aorta, the anterior wall had higher plaque density than the posterior side, although the two sides showed strong plaque coexistence. Furthermore, there was an unexpectedly high risk of plaque interference during cannulation and/or clamp maneuvers if blindly performed. The present results emphasize the importance of epiaortic scanning.
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