title: Combined aortic valve replacement and coronary artery bypass grafting with in situ arterial grafts for porcelain aorta.
abstract: Patients with porcelain aorta carry a high risk of cerebral as well as systemic embolism during cardiac surgery. Here we describe a case of severe aortic stenosis and coronary artery disease combined with the circumferentially calcified aorta. The patient was a 77-year-old man who successfully received four coronary artery bypass grafts with in situ arterial grafts without clamping the aorta and aortic valve replacement. Aortic valve replacement and two distal coronary artery anastomoses to the left circumflex artery and obtuse marginal branch were performed under cardiac arrest during hypothermic perfusion with endoaortic balloon occlusion, followed by partial endarterectomy and closure of the aorta buttressed with bovine pericardium under deep hypothermic circulatory arrest. While rewarming, the other two distal coronary anastomoses to the left anterior descending artery and diagonal branch were done on the beating heart in order to minimize cardiac arrest time. On-pump beating heart coronary artery bypass grafting (CABG) can be useful especially for combined complex cardiac surgery.
authors.affiliation: Department of Cardiovascular Surgery, National Hospital Kure Medical Center, Hiroshima, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Tamura
authors.forename: Fumikazu
authors.initials: F
authors.lastname: Nomura
authors.forename: Shogo
authors.initials: S
authors.lastname: Mukai
authors.forename: Masao
authors.initials: M
authors.lastname: Yoshitatsu
authors.forename: Jun
authors.initials: J
authors.lastname: Sakao
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Ihara
mesh_terms: D000368:Aged; D001018:Aortic Diseases / Q000150:complications / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000150:complications / Q000601:surgery*; D002114:Calcinosis; D001026:Coronary Artery Bypass / Q000379:methods*; D003324:Coronary Artery Disease / Q000150:complications / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D016896:Treatment Outcome