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Clampless technique during coronary artery bypass grafting for proximal anastomoses in the hostile aorta
Rawn Salenger1, Evelio Rodriquez, Jimmy T Efird
1Department of Cardiac Surgery, Good Samaritan Regional Medical Center, Suffern, NY 10901, USA. rawn_salenger@bshsi.org
Insights
This study presents a safe, clampless heart surgery technique for coronary artery bypass grafting in patients with severe aortic disease, significantly reducing stroke risk and enabling full revascularization.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Vascular Medicine
Background:
- Coronary artery bypass grafting (CABG) carries an increased stroke risk in patients with severe atherosclerotic disease of the ascending aorta.
- Minimizing cerebral embolic events is crucial for this high-risk patient population.
Purpose of the Study:
- To describe and evaluate a novel surgical technique for CABG in patients with significant ascending aorta atherosclerosis.
- To assess the safety and efficacy of this technique in reducing perioperative stroke incidence.
Main Methods:
- Intraoperative epiaortic ultrasound to identify safe cannulation and anastomosis sites on the ascending aorta.
- A clampless, mildly hypothermic, fibrillating technique for distal revascularization.
- Brief periods of circulatory arrest for proximal anastomoses.
Main Results:
- The technique was applied to 71 consecutive patients with grade 3 or higher atherosclerotic plaque in the ascending aorta (10% of total CABG population).
- A single patient (1.4%) experienced a mild, transient stroke.
- No other neurological complications were observed.
Conclusions:
- Clampless fibrillating heart surgery with circulatory arrest is a safe and effective method for CABG in patients with severe ascending aortic disease.
- This approach minimizes cerebral embolic risk, allowing for complete revascularization.
Objective:
The incidence of stroke in patients undergoing coronary artery bypass grafting increases sharply in the face of significant atherosclerotic disease of the ascending aorta. We use a technique that allows full revascularization for this cohort of patients, while minimizing cerebral embolic risk.
Methods:
Intraoperative epiaortic ultrasound was used to screen for moderate or severe atherosclerotic disease of the ascending aorta and to precisely identify safe areas for cannulation and proximal anastomoses. By using a mildly hypothermic fibrillating technique, distal revascularization was then performed without clamping the aorta. Proximal anastomoses were accomplished under brief periods of circulatory arrest.
Results:
We routinely use this technique and examined our results in 71 consecutive patients found to have grade 3 or greater atherosclerotic plaque of the ascending aorta. This represented approximately 10.0% of our total population who underwent coronary artery bypass grafting over a 32-month period from January 2007 to September 2009. One patient (1.4%) had a mild stroke that resolved, and there were no other neurologic complications.
Conclusions:
We have found that clampless fibrillating heart surgery with circulatory arrest for proximal anastomoses is a safe and effective technique for revascularizing patients with significant ascending aortic disease who are at high risk for cerebral embolic complications.
