title: Modified bypass procedure and apicoaortic conduit. Management of coronary artery disease, aortic valve stenosis and porcelain aorta.
abstract: BACKGROUND
  In case of severely calcified ascending aorta, modified operative strategies are required in order to avoid manipulations of the aorta and minimize subsequent cerebral vascular accidents.
  
  
  METHODS
  A 73-year-old woman, with a coronary two-vessel disease and aortic stenosis was scheduled for coronary artery bypass grafting and aortic valve replacement. Due to severed calcification of the ascending aorta including the transverse arch, neither cannulation, clamping nor incision of the aorta or its replacement was feasible. Therefore bypass operation was performed using a modified approach. After 1 month, implantation of a valved conduit between the left ventricular apex and the descending aorta through a lateral thoracotomy followed.
  
  
  CONCLUSIONS
  Only in few cases the surgical treatment of a coronary artery disease in combination with left ventricular outflow tract obstruction and heavily calcified ascending aorta has been described. Undoubtedly, creation of an apicoaortic connection is today only indicated in the adult population in a small collective with multiple previous operations or porcelain aorta.
authors.affiliation: German Heart Center Munich, Clinic for Cardiovascular Surgery, Tehnical University, Germany. schreiber@dhm.mhn.de
authors.forename: Christian
authors.initials: C
authors.lastname: Schreiber
authors.forename: Norbert
authors.initials: N
authors.lastname: Augustin
authors.forename: Robert
authors.initials: R
authors.lastname: Bauernschmitt
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Lange
mesh_terms: D000368:Aged; D001011:Aorta / Q000601:surgery; D001013:Aorta, Thoracic / Q000601:surgery; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography; D001161:Arteriosclerosis / Q000000981:diagnostic imaging / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000601:surgery*; D003131:Combined Modality Therapy; D001026:Coronary Artery Bypass / Q000379:methods*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000379:methods; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D012086:Reoperation / Q000379:methods; D014057:Tomography, X-Ray Computed; D014680:Veins / Q000637:transplantation; D014694:Ventricular Outflow Obstruction / Q000601:surgery