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[Coronary artery bypass grafting in cases with the atherosclerotic ascending aorta]
Insights
Severely atherosclerotic ascending aorta during coronary artery bypass grafting poses risks. Alternative techniques like hypothermic circulatory arrest may reduce cerebral infarction events.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Cardiac Anesthesia
Background:
- Coronary artery bypass grafting (CABG) is a common procedure.
- Severely atherosclerotic ascending aorta presents a surgical challenge during CABG.
- Traditional aortic clamping techniques may increase the risk of complications.
Observation:
- Nine out of 172 CABG cases (5%) exhibited severe ascending aorta atherosclerosis.
- Various aortic manipulation techniques were employed in these cases, including total and partial aortic cross-clamping.
- Cerebral infarction occurred in 3 out of 7 cases involving aortic clamping.
Findings:
- Hypothermic circulatory arrest (HCA) was utilized in 2 cases without aortic clamping.
- In one case, HCA was initiated during saphenous vein graft (SVG) proximal anastomosis.
- In another case, HCA was used to resect the diseased aortic segment before SVG anastomosis to a Dacron patch.
- No cerebral infarctions were observed in the two patients managed with HCA and aortic resection/patching.
Implications:
- Atherosclerosis of the ascending aorta necessitates careful surgical planning in CABG.
- Techniques avoiding or minimizing aortic cross-clamping, such as HCA, may be safer.
- HCA offers a viable alternative for managing ascending aorta atherosclerosis during CABG, potentially reducing embolic events and improving patient outcomes.
Abstract:
Among 172 cases of coronary artery bypass grafting, 9 cases (5%) revealed severely atherosclerotic ascending aorta. In 3 of the 9 cases, total aortic cross-clamping in the distal anastomoses of saphenous vein graft (SVG) and partial aortic clamp in the proximal anastomoses of SVG were performed. In 1 case with this technique, cerebral infarction was occurred. In 4 cases, total aortic cross-clamping in the distal and proximal anastomoses of SVG was performed. In 2 of these cases with this technique, cerebral infarctions were occurred. Hypothermic circulatory arrest was performed in 2 of the rest. In one case that was predicted to have atherosclerosis of ascending aorta prior to operation, the left internal thoracic artery was anastomosed to the left anterior descending, and SVG to the right coronary artery with hypothermia and ventricular fibrillation. And during the proximal anastomoses of SVG, hypothermic circulatory arrest without aortic clamping was initiated. In another case, atherosclerosis of ascending aorta was noted after aortic cross-clamping. Then the aorta was declamped, hypothermic circulatory arrest was established, the aorta was opened, the diseased segment was resected, and proximal anastomoses of SVG was performed to Dacron patch which was implanted for aortic wall. There were no cerebral infarction in last two patients.