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A Journal on Cardiac, Vascular and Thoracic Surgery

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The Journal of Cardiovascular Surgery 2003 April;44(2):217-21

language: English

Off-pump coronary artery revascularization: ideal indication for patients with porcelain aorta and calcification of great vessels

Bittner H. B., Savitt M. A., Ching P. V., Ward H. B.

Divi­sion of Car­di­o­vas­cular and Tho­racic Sur­gery, Uni­ver­sity of Min­ne­sota, Min­ne­ap­olis, MN, USA


­Patients ­with por­ce­lain ­aorta and ­severe cal­cifi­ca­tion of the ­great ves­sels are a chal­lenging ­dilemma for the car­di­o­vas­cular sur­geon ­regarding ­bypass tech­nique, ­choice of con­duit, and selec­tion of prox­imal anas­to­motic ­sites due to the ­high inci­dence of dev­as­tating throm­boem­bol­iza­tion and ­aortic ­injury. No cur­rently pro­posed sur­gical ­approach ­avoids manip­u­la­tion of the ­heavily cal­ci­fied ­ascending ­aorta. ­Three ­patients pre­sented ­with ­unstable ­angina and ­decreased ven­tric­ular func­tion sec­on­dary to sig­nif­i­cant ­left ­main cor­o­nary ­artery sten­osis and 3-­vessel cor­o­nary ­artery dis­ease. In addi­tion to the cor­o­nary ­artery dis­ease, ­severely cal­ci­fied ­ascending ­aorta and ­great ves­sels ­were dis­cov­ered. One ­patient pre­sented ­with ­near ­total ­distal abdom­inal ­aortic occlu­sion, ­severe periph­eral vas­cular dis­ease, his­tory of ­stroke, and ­carotid endar­te­rec­tomy. Sur­gical cor­o­nary revas­cu­lar­iza­tion was indi­cated. Cor­o­nary ­artery ­bypass ­grafting ­using ­internal tho­racic ­artery and ­greater saph­e­nous ­vein com­posite arte­rial ­inflow ­grafts in com­bi­na­tion ­with off-­pump ­beating ­heart sur­gery was suc­cess­fully ­used. Car­di­o­pul­mo­nary ­bypass and ­clamping of the ­aorta was ­avoided. No new neu­ro­logic def­icit was ­observed. Cor­o­nary revas­cu­lar­iza­tion ­with ­internal tho­racic ­artery com­posite ­grafts and ­avoiding car­di­o­pul­mo­nary ­bypass and ­clamping the cal­ci­fied ­aorta is an effec­tive ­method to pre­vent ­clamp ­injury and throm­boem­bol­iza­tion. Off-­pump cor­o­nary ­artery ­bypass ­grafting ­seems to be an ­ideal indi­ca­tion in ­patients ­with por­ce­lain ­aorta ­because the sur­gical tech­niques of “no-­touch” and “no-can­nu­la­tion” can be ­applied.

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