title: 'No touch' techniques for porcelain ascending aorta: comparison between cardiopulmonary bypass with femoral artery cannulation and off-pump myocardial revascularization.
abstract: BACKGROUND
  Detection of severe atherosclerotic ascending aorta during coronary artery bypass grafting requires alterations in the standard surgical technique to reduce the probability of stroke-related atheroembolization. Off-pump coronary artery bypass grafting (OPCAB) confers the benefits of avoiding aortic cannulation and clamping, and may therefore attenuate this risk.
  
  
  METHODS
  OPCAB (n = 41) was compared to cardiopulmonary bypass (CPB) using femoral arterial cannulation and hypothermic fibrillatory arrest (n = 15), in patients with porcelain ascending aorta undergoing myocardial revascularization. In both groups, a 'no touch' technique was applied by avoiding aortic cannulation and clamping. Proximal anastomoses on the atherosclerotic aorta were avoided by arterial grafting, (in-situ or T-graft configurations) in all cases.
  
  
  RESULTS
  Operative mortality was comparable (2.4% and 6.6% in the OPCAB and CPB groups respectively, p = NS). The rate of adverse neurological events, (two strokes and one transient ischemic attack), was higher in the CPB group (p = 0.0164). Based on brain CT, the nature of the recorded stroke suggested retrograde emboli. Three year survival (Kaplan-Meier) for the OPCAB and CPB groups was 86.7% and 81.3%, respectively (p = NS). Occurrence of late neurological adverse events during follow-up (8-51 months) was similar.
  
  
  CONCLUSIONS
  In patients with porcelain ascending aorta undergoing myocardial revascularization, neurological outcome of OPCAB patients is better than CPB using femoral artery cannulation.
authors.affiliation: Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Sackler Faculty of Medicine, Tel Aviv University, Israel.
authors.forename: Oren
authors.initials: O
authors.lastname: Lev-Ran
authors.forename: Yanai
authors.initials: Y
authors.lastname: Ben-Gal
authors.forename: Menachem
authors.initials: M
authors.lastname: Matsa
authors.forename: Yosef
authors.initials: Y
authors.lastname: Paz
authors.forename: Amir
authors.initials: A
authors.lastname: Kramer
authors.forename: Dimitry
authors.initials: D
authors.lastname: Pevni
authors.forename: Chaim
authors.initials: C
authors.lastname: Locker
authors.forename: Gideon
authors.initials: G
authors.lastname: Uretzky
authors.forename: Rephael
authors.initials: R
authors.lastname: Mohr
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001018:Aortic Diseases / Q000601:surgery*; D001161:Arteriosclerosis / Q000601:surgery*; D002114:Calcinosis / Q000601:surgery*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D002404:Catheterization / Q000379:methods; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D005260:Female; D005263:Femoral Artery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods / Q000401:mortality; D018709:Statistics, Nonparametric; D020521:Stroke / Q000209:etiology