Abstract
BackgroundCannulation, cross clamping, or partial clamping of the aorta during a proximal anastomosis may cause embolic complications in patients with severely atherosclerotic (porcelain) aortas. These patients carry high morbidity and mortality risks due to intraoperative atheroembolism.MethodsBetween June 2008 and May 2010, 972 open heart surgery operations were performed in our department. In this group there were 41 patients who had severe atherosclerotic plaques in the aorta (porcelain aorta), and 9 of these underwent an extraanatomical coronary artery bypass grafting (CABG). These 9 patients were retrospectively analyzed and their demographic data, patient risk factors, and preferred surgical methods were reviewed.ResultsSeven patients underwent two-vessel CABG, while 2 underwent three-vessel CABG. Off-pump surgery was performed for 7 patients. CABG was performed with beating heart technique under cardiopulmonary bypass via femoral artery and right atrial cannulation without cross clamping in 2 of the patients. Postoperative course was uneventful in all patients. Mean length of stay in the intensive care unit was 2.11 ± 0.78 days. Mean hospitalization was 7.22 ± 0.97 days. Mean follow-up was 11.33 ± 3.67 months, and no cerebrovascular events were observed during this period. Postoperative evaluation of the grafts by multislice computed tomography revealed sufficient patency in all patients.ConclusionsInnominate artery is an alternative inflow source for the untouchable ascending aorta caused by severe atherosclerotic disease (porcelain aorta). In this group of patients, the risk of systemic embolisation and perioperative neurologic complications can be minimized by avoiding manipulation of the ascending aorta and using the innominate artery.
Highlights
Cannulation, cross clamping, or partial clamping of the aorta during a proximal anastomosis may cause embolic complications in patients with severely atherosclerotic aortas
This study included only patients in whom the innominate artery was used for the proximal anastomotic site with left internal mammarian artery (LİMA) to left anterior descending artery (LAD) bypass
The most common risk factor was smoking, which was present in 77.8% of the patients, and was followed in order by hypertension, diabetes mellitus, chronic obstructive pulmonary disease (COPD) and peripheral arterial disease
Summary
Cannulation, cross clamping, or partial clamping of the aorta during a proximal anastomosis may cause embolic complications in patients with severely atherosclerotic (porcelain) aortas. These patients carry high morbidity and mortality risks due to intraoperative atheroembolism. Atherosclerotic aorta is a potent risk factor for perioperative atheroembolism, causing increased morbidity and mortality during cardiac operations [1,2,3]. The incidence of significant atherosclerosis of the ascending aorta in patients undergoing cardiac surgery have been reported to be between 14% and 29% in recent studies [5,6,7]. A strong correlation between atheroembolism and atherosclerosis of the ascending aorta was documented at autopsy by Blauth and coworkers who showed that most of the patients who had evidence of atheroemboli and died after cardiac surgery had extensive atherosclerosis of the ascending aorta [12]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
