Comprehensive approach for clamping severely calcified ascending aorta using computed tomography

Area of Science:

• Cardiovascular Surgery
• Medical Imaging

Background:

• Severely calcified ascending aorta poses a challenge for cardiac surgery, often necessitating complex alternative procedures.
• Conventional aortic cross-clamping can be difficult or impossible in cases of severe aortic calcification.

Purpose of the Study:

• To assess a comprehensive strategy for safely clamping severely calcified ascending aortas.
• To evaluate the utility of preoperative computed tomography (CT) in guiding aortic clamping decisions.

Main Methods:

• Preoperative CT scans were used to assess the extent of calcification, particularly below the innominate artery.
• Ascending aorta was clamped using a soft cross-clamp, oriented parallel to calcification, if <75% circumference was involved.
• Operations were performed under standard cardiopulmonary bypass with mild hypothermia.

Main Results:

• Preoperative CT identified less calcification below the innominate artery compared to the standard clamping site.
• All patients (n=?) survived surgery without postoperative neurological complications.
• The described clamping strategy was successfully applied in patients with severely calcified aortas.

Conclusions:

• A comprehensive strategy utilizing preoperative CT enables safe clamping of severely calcified ascending aortas.
• This approach offers a less invasive alternative to other methods for managing high-risk patients.
• Careful clamp selection and placement are crucial for optimal outcomes in these challenging cases.