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Wash out technique for proximal anastomosis in atherosclerotic ascending aorta
M Genoni1, M Lachat, J Schmidli
1Clinic for Cardiovascular Surgery, University Hospital, Zurich, Switzerland.
Insights
The "wash out technique" for coronary artery bypass grafting effectively minimizes embolization from aortic atheromatous plaques in elderly patients. This method ensures a safer surgical outcome by reducing cardiac and cerebral events.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Cardiac Surgery
Background:
- Atheromatous plaques in the ascending aorta are a significant cause of cardiac and cerebral events during coronary bypass surgery, particularly in elderly patients.
- Smooth aortic atheromatous degeneration is often undetectable, even with transesophageal echocardiography, posing a risk during surgery.
Purpose of the Study:
- To evaluate the efficacy of the "wash out technique" in minimizing embolization during coronary artery bypass grafting in patients with unexpected atheromatous pathology of the ascending aorta.
Main Methods:
- The "wash out technique" was performed in four patients with unexpected atheromatous material in the ascending aorta.
- This involved creating a side-to-end anastomosis with a vein segment, allowing the aorta to bleed through the venous stump to clear debris.
- Coronary bypass graft completion followed, with patients receiving long-term oral anticoagulation and low-dose antiplatelet therapy.
Main Results:
- All four patients experienced an uncomplicated postoperative course.
- Notably, there were no instances of neurological damage or electrocardiogram (ECG) changes post-surgery.
Conclusions:
- The "wash out technique" is effective in minimizing direct embolization into the cardiac area perfused by new bypass grafts.
- This technique offers a safer approach for coronary artery bypass grafting in patients with identified atheromatous pathology of the ascending aorta.
Background:
Especially among elderly patients embolisms originating from atheromatous plaques in the ascending aorta are responsible for cardiac and cerebral events during coronary bypass surgery. Unfortunately smooth atheromatous degeneration of the aorta often can not be detected even by transoesophageal echocardiography.
Methods:
In four patients with unexpected atheromatous material of the punched ascending aorta the so called "wash out technique" was performed. A side-to-end anastomosis between a segment of vein and the partially clamped ascending aorta was performed. For several minutes the ascending aorta was left to bleed through the venous stump. Without further manipulation of the ascending aorta the coronary bypass graft was completed by an end-to-end anastomosis between the venous stump and the venous graft. Oral anticoagulation in combination with a low dose platelet antiaggregation drug was given for at least one year.
Results:
All patients had an uncomplicated postoperative course, especially with regard to neurological damage or ECG changes.
Conclusions:
In patients with unexpected atheromatous pathology of the ascending aorta the "wash out technique" of coronary artery bypass grafting minimises direct embolisation into the cardiac area perfused by the new bypass grafts.