title: Replacing the atherosclerotic ascending aorta is a high-risk procedure.
abstract: BACKGROUND
  Improved techniques in cerebral and myocardial protection have made replacement of the chronically aneurysmal ascending thoracic aorta a safe and effective procedure. We hypothesized that patients with severe ascending or aortic arch atherosclerosis were at greater risk for operative complications during ascending aortic replacement because of the diffuse nature of their atherosclerotic process.
  
  
  METHODS
  We retrospectively analyzed the records of 17 patients who received ascending aortic replacement during elective coronary artery bypass grafting (CABG) because of the intraoperative finding of severe atherosclerosis. All 17 patients underwent tube graft replacement of the ascending aorta under hypothermic circulatory arrest and retrograde cerebral perfusion before coronary artery bypass grafting. The outcomes for these patients were compared with those of a control group of 89 consecutive patients who underwent replacement for ascending thoracic aortic aneurysm.
  
  
  RESULTS
  The hospital mortality rate for replacement of the ascending thoracic aorta for severe atherosclerosis was 23.5% (4/17) versus 2.25% (2 of 89) for the control group (p=0.006). The incidence of cerebrovascular accident in the atherosclerotic group was 17.6% (3/17) and 3.37% (3/89) for the control group (p=0.051). Nine of 17 atherosclerotic patients (52.9%) had operative morbidity. Only 20.2% (18 of 89) of the control patients had nonfatal postoperative complications.
  
  
  CONCLUSIONS
  The severely atherosclerotic ascending aorta is a marker of diffuse atherosclerosis. Despite improved techniques of myocardial and cerebral protection, we have been unable to duplicate our success with ascending thoracic aneurysm repair. Preoperative screening of the ascending aorta by chest computed tomography may be appropriate in select high-risk patients to determine operability.
authors.affiliation: Department of Surgery, University of Virginia Health Sciences Center, Charlottesville 22908, USA.
authors.forename: R C
authors.initials: RC
authors.lastname: King
authors.forename: R C
authors.initials: RC
authors.lastname: Kanithanon
authors.forename: K S
authors.initials: KS
authors.lastname: Shockey
authors.forename: W D
authors.initials: WD
authors.lastname: Spotnitz
authors.forename: C G
authors.initials: CG
authors.lastname: Tribble
authors.forename: I L
authors.initials: IL
authors.lastname: Kron
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000601:surgery; D001018:Aortic Diseases / Q000401:mortality / Q000601:surgery*; D001161:Arteriosclerosis / Q000401:mortality / Q000601:surgery*; D001026:Coronary Artery Bypass; D005260:Female; D006801:Humans; D008297:Male; D008722:Methods; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies