title: Myocardial revascularization using the "no-touch" technique, with mild systemic hypothermia, in patients with a calcified ascending aorta.
abstract: Modifications in the standard technique for coronary artery bypass grafting are recommended in presence of a calcified ascending aorta, to avoid clamp injury or atheroembolism. Between January 1991 and August 1994, we used a "no-touch" technique in 18 patients undergoing myocardial revascularization, who had a heavily calcified and atherosclerotic ascending aorta. Their mean age was 76.1 years (range 63 to 82 years). Cardiopulmonary bypass with mild systemic hypothermia (32 degrees C) was employed in 16 patients; 2 other patients were operated upon without cardiopulmonary bypass. The "no-touch" technique avoids all types of clamps in the aorta. No cardioplegia was given, and no grafts were anastomosed to the aorta. Fifty-two distal anastomoses (mean: 2.9 per patient) were performed, using 37 pedicled arterial grafts (22 internal mammary and 15 gastroepiploic arteries), and 15 free grafts, which were anastomosed proximally to the internal mammary artery. There were no postoperative cerebrovascular accidents. Three patients died (16.7% overall mortality): 1 died of pneumonia, one patient with a large left ventricular aneurysm died in congestive heart failure, and one patient with associated aortic insufficiency died in low cardiac output. Our experience suggests that using pedicled arterial grafts for myocardial revascularization is safe and effective to avoid clamp injury or atheroembolism in patients with a calcified aorta. Deep hypothermia is not necessary when using the "no-touch" technique.
authors.affiliation: Department of Cardiology, Geisinger Medical Center, Danville PA 17822-1343, USA.
authors.forename: C A
authors.initials: CA
authors.lastname: Dietl
authors.forename: N P
authors.initials: NP
authors.lastname: Madigan
authors.forename: C A
authors.initials: CA
authors.lastname: Laubach
authors.forename: J H
authors.initials: JH
authors.lastname: Chapman
authors.forename: J P
authors.initials: JP
authors.lastname: Bering
authors.forename: P H
authors.initials: PH
authors.lastname: Holcomb
authors.forename: M J
authors.initials: MJ
authors.lastname: Larkin
authors.forename: F J
authors.initials: FJ
authors.lastname: Menapace
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000789:Angina, Unstable / Q000601:surgery; D001011:Aorta / Q000601:surgery; D001018:Aortic Diseases / Q000601:surgery*; D001158:Arteries / Q000637:transplantation; D001161:Arteriosclerosis / Q000601:surgery*; D002114:Calcinosis / Q000601:surgery*; D002315:Cardiopulmonary Bypass / Q000379:methods; D001026:Coronary Artery Bypass / Q000379:methods*; D004630:Emergencies; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012501:Saphenous Vein / Q000637:transplantation; D013524:Surgical Flaps