title: Extraanatomical coronary artery bypass grafting in patients with severely atherosclerotic (Porcelain) aorta.
abstract: BACKGROUND
  Cannulation, cross clamping, or partial clamping of the aorta during a proximal anastomosis may cause embolic complications in patients with severely atherosclerotic (porcelain) aortas. These patients carry high morbidity and mortality risks due to intraoperative atheroembolism.
  
  
  METHODS
  Between June 2008 and May 2010, 972 open heart surgery operations were performed in our department. In this group there were 41 patients who had severe atherosclerotic plaques in the aorta (porcelain aorta), and 9 of these underwent an extraanatomical coronary artery bypass grafting (CABG). These 9 patients were retrospectively analyzed and their demographic data, patient risk factors, and preferred surgical methods were reviewed.
  
  
  RESULTS
  Seven patients underwent two-vessel CABG, while 2 underwent three-vessel CABG. Off-pump surgery was performed for 7 patients. CABG was performed with beating heart technique under cardiopulmonary bypass via femoral artery and right atrial cannulation without cross clamping in 2 of the patients. Postoperative course was uneventful in all patients. Mean length of stay in the intensive care unit was 2.11 ± 0.78 days. Mean hospitalization was 7.22 ± 0.97 days. Mean follow-up was 11.33 ± 3.67 months, and no cerebrovascular events were observed during this period. Postoperative evaluation of the grafts by multislice computed tomography revealed sufficient patency in all patients.
  
  
  CONCLUSIONS
  Innominate artery is an alternative inflow source for the untouchable ascending aorta caused by severe atherosclerotic disease (porcelain aorta). In this group of patients, the risk of systemic embolisation and perioperative neurologic complications can be minimized by avoiding manipulation of the ascending aorta and using the innominate artery.
authors.affiliation: Department of Cardiovascular Surgery, Goztepe Medical Park Hospital, E5 Uzeri 23 Nisan Sok, No: 17 Merdivenkoy Kadıkoy, Istanbul, Turkey. sirin.gokce@yahoo.com
authors.forename: Gokce
authors.initials: G
authors.lastname: Sirin
authors.forename: Kamil
authors.initials: K
authors.lastname: Sarkislali
authors.forename: Murat
authors.initials: M
authors.lastname: Konakci
authors.forename: Ergun
authors.initials: E
authors.lastname: Demirsoy
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000601:surgery*; D001018:Aortic Diseases / Q000601:surgery*; D050197:Atherosclerosis / Q000601:surgery*; D001026:Coronary Artery Bypass / Q000379:methods*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors