Coronary artery bypass grafting in patients with calcified ascending aorta: aortic no-touch technique

Area of Science:

• Cardiovascular Surgery
• Cardiac Anesthesia

Background:

• Severe atherosclerotic lesions in the ascending aorta pose a significant challenge for coronary artery bypass grafting (CABG).
• Traditional CABG techniques involving aortic cross-clamping can increase the risk of perioperative complications in these patients.

Purpose of the Study:

• To evaluate the safety and efficacy of a novel "aortic no-touch technique" for CABG in patients with severe ascending aorta calcification.
• To assess the feasibility of performing CABG without aortic cross-clamping in high-risk patients.

Main Methods:

• The aortic no-touch technique involved maximal use of in situ arterial grafts, fibrillatory arrest without aortic cross-clamp, left ventricular venting via the right superior pulmonary vein, and femoral artery perfusion.
• The technique was applied to three male patients (ages 56-70) with triple-vessel disease and severe ascending aorta calcification.
• Bilateral internal mammary arteries and the right gastroepiploic artery were utilized in all cases.

Main Results:

• All three patients survived the procedure.
• No evidence of perioperative myocardial infarction or cerebrovascular accident was observed.
• The technique successfully facilitated CABG in the presence of severe aortic calcification.

Conclusions:

• The aortic no-touch technique is a safe and viable option for performing CABG in patients with heavily calcified ascending aortas.
• This approach mitigates the risks associated with aortic cross-clamping in this high-risk population.
• Further studies are warranted to confirm these findings in a larger cohort.