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Innominate artery as an alternative site for proximal anastomoses in patients with a severely calcified aorta

Ibrahim Uyar1, Tolga Demir, Adil Polat

  • 1Department of Cardiovascular Surgery, JFK Hospital, Istanbul, Turkey.

Journal of Cardiac Surgery
|May 17, 2013
PubMed

Insights

Proximal anastomoses on the innominate artery are a safe alternative for coronary artery bypass grafting (CABG) in patients with calcific atheromatous plaques (CAP) in the ascending aorta, reducing operative risks.

Area of Science:

  • Cardiovascular Surgery
  • Vascular Surgery
  • Cardiac Anesthesia

Background:

  • Ascending aorta atheromatous plaques are significant risk factors for mortality and morbidity in coronary artery bypass grafting (CABG).
  • Intraoperative detection of calcific atheromatous plaques (CAP) necessitates alternative surgical strategies.

Purpose of the Study:

  • To evaluate the safety and efficacy of using the innominate artery for proximal anastomoses in CABG patients with CAP.
  • To assess outcomes and complications associated with this alternative grafting strategy.

Main Methods:

  • Retrospective review of 16 consecutive CABG patients with intraoperatively detected CAP between November 2006 and June 2009.
  • Off-pump surgery was performed, with proximal anastomoses constructed on the innominate artery, left internal thoracic artery (LITA), or saphenous vein grafts (SVG).

Main Results:

  • A total of 25 proximal anastomoses were performed on the innominate artery.
  • One patient (6.2%) experienced cerebrovascular morbidity; no other complications were observed.
  • Various sequential grafting strategies were employed, including SVG and LITA.

Conclusions:

  • The innominate artery serves as a viable alternative site for proximal anastomoses in CABG patients presenting with calcific atheromatous aorta.
  • This approach can mitigate risks associated with ascending aorta manipulation in high-risk patients.
Abstract

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