Aortic plaque distribution in relation to cross clamp and cannulation procedures during cardiac surgery.
OBJECTIVE
Aortic atherosclerosis may cause cerebrovascular accidents in cardiac surgery. Aortic plaque distribution was analyzed in relation to surgical manipulation.


METHODS
In 24 autopsy subjects the thoracic aorta was digitally analyzed by macro-anatomic mapping of plaques. Plaque density was compared in different anatomical segments. Hazards associated with surgical manipulation were blindly studied by superimposing cannulation and cross-clamp locations onto the maps.


RESULTS
Plaques were frequent. The anterior wall of the ascending/arch aorta had higher plaque density than its posterior side (p=0.039). However, an anterior plaque predicted to 83% a concomitant plaque in the posterior wall. Plaque formation correlated with age (p=0.004). The theoretical risk of interfering with a plaque during cannulation and/or clamp positioning was 46%.


CONCLUSIONS
Plaque formation is a frequent and age-dependent problem. In the surgery-exposed aorta, the anterior wall had higher plaque density than the posterior side, although the two sides showed strong plaque coexistence. Furthermore, there was an unexpectedly high risk of plaque interference during cannulation and/or clamp maneuvers if blindly performed. The present results emphasize the importance of epiaortic scanning.
Boivie
Patrik
P
Department of Surgical and Perioperative Sciences, Umeå University Hospital, Umeå, S-901 85, Sweden. patrik.boivie@vll.se
Hansson
Magnus
M
Engström
Karl Gunnar
KG
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000473:pathology* / Q000601:surgery*; D050197:Atherosclerosis / Q000473:pathology*; D001344:Autopsy / Q000379:methods*; D002102:Cadaver; D002113:Calcification, Physiologic; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D002404:Catheterization / Q000379:methods*; D002423:Cause of Death; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000209:etiology