A no-touch technique for calcified ascending aorta during coronary artery surgery.
Despite improvements in cardiovascular surgery techniques over the years, the incidence of neurologic complications has not declined, and stroke remains a possible (and devastating) sequela to coronary artery surgery. In this report, we describe a moderate hypothermic fibrillatory arrest technique that avoids cross-clamping or otherwise touching the aorta; use of the internal thoracic arteries and the right gastroepiploic artery provides optimum revascularization and minimizes the risk of cerebrovascular accident. Over a 1-year period, we used the technique in 21 patients who had heavy calcifications of the ascending aorta. No hemodynamic problems, lower-limb ischemia, or neurologic complications were seen. Only 1 patient underwent reoperation (for bleeding), and another--whose revascularization was incomplete--had a high postoperative level of myocardial creatine kinase MB isoenzyme and a new Q wave, but no hemodynamic deterioration. This technique seems reasonable, because it appears to provide good myocardial protection and to reduce neurologic complications, without comprising myocardial revascularization.
Akpinar
B
B
Department of Cardiovascular Surgery, Florence Nightingale Hospital, Istanbul, Turkey.
Güden
M
M
Sanisoğlu
I
I
Konuralp
C
C
Yilmaz
O
O
Sönmez
B
B
D000328:Adult; D000368:Aged; D001011:Aorta; D001018:Aortic Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D002114:Calcinosis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000209:etiology / Q000601:surgery; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014656:Vascular Surgical Procedures / Q000379:methods*