Complete thromboendarterectomy of the calcified ascending aorta and aortic arch.
BACKGROUND
Arteriosclerotic plaques of the ascending aorta and transverse arch increase the operative risk of cardiac operations and are strong predictors for late cerebrovascular events.


METHODS
Twenty-two patients, mean age 68 +/- 6 years (range, 55 to 77 years), with grade IV + V plaques of the ascending aorta and transverse arch underwent coronary artery bypass grafting (n = 21) and aortic valve replacement (n = 8). Cerebrovascular emboli from unknown sources were found preoperatively in 8 patients (36%). All were in sinus rhythm. Complete thromboendarterectomy of the ascending aorta and transverse arch was performed during hypothermic circulatory arrest. After 21 +/- 12 months (range, 4 to 44 months), magnetic resonance imaging and transthoracic echocardiography of endarterectomized vessels was performed.


RESULTS
There was one perioperative death (4.5%), one early (4.5%), and one late (4.7%) adverse neurologic event. Follow-up examinations revealed normal diameters of the endarterectomized aorta.


CONCLUSIONS
For patients with grade IV + V plaques, thromboendarterectomy of the ascending aorta and transverse arch can be performed with an acceptable surgical risk and a low recurrence rate for cerebrovascular events. Dilatation of the endarterectomized aorta was not observed.
Vogt
P R
PR
Clinic for Cardiovascular Surgery, Institute for Diagnostic Radiology, Department of Neurology, University Hospital, Zurich, Switzerland.
Hauser
M
M
Schwarz
U
U
Jenni
R
R
Lachat
M L
ML
Zünd
G
G
Schüpbach
R W
RW
Schmidlin
D
D
Turina
M I
MI
D000368:Aged; D001011:Aorta / Q000473:pathology / Q000601:surgery; D001013:Aorta, Thoracic / Q000473:pathology / Q000601:surgery; D001161:Arteriosclerosis / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D002423:Cause of Death; D001026:Coronary Artery Bypass; D004691:Endarterectomy / Q000295:instrumentation*; D005260:Female; D006324:Heart Arrest, Induced; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D002542:Intracranial Embolism and Thrombosis / Q000175:diagnosis / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality