Shaggy and calcified aorta: surgical implications

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Atherosclerosis Research

Background:

• Atheroembolism is a growing concern in cardiovascular surgery, particularly affecting elderly patients.
• Severe thoracic aortic atherosclerosis often indicates widespread systemic atherosclerosis.
• Proactive evaluation of the aorta is critical for at-risk patients.

Purpose of the Study:

• To outline strategies for preventing atheroembolism during cardiovascular surgery.
• To discuss optimal arterial perfusion techniques for patients with severe aortic atherosclerosis.
• To review current and future management options for complex aortic conditions.

Main Methods:

• Utilizing advanced imaging (enhanced CT, transesophageal echocardiography, epiaortic ultrasound) for preoperative and intraoperative aortic assessment.
• Implementing specific perfusion strategies: central cannulation, axillary perfusion, and femoral artery perfusion.
• Employing circulatory arrest with or without cerebral perfusion for severe atherosclerosis cases.

Main Results:

• Central cannulation under ultrasound guidance is effective for atherosclerotic aortic arch aneurysms.
• Axillary perfusion offers an alternative but requires caution with specific patient anatomies.
• Femoral artery perfusion carries a risk of paradoxical embolism, comparable to axillary perfusion when preoperative screening is thorough.
• Circulatory arrest is a key strategy for porcelain aorta, with surgical options potentially decreasing due to transcatheter valve replacement.

Conclusions:

• Careful selection of arterial perfusion sites and meticulous surgical technique are paramount to prevent atheroembolism.
• Circulatory arrest and hypothermia are important adjuncts for managing severe aortic atherosclerosis.
• Future management may shift towards less invasive, transcatheter approaches for certain aortic conditions.