TECHNICAL NOTES  CARDIAC SECTION 

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

Copyright © 2009 EDIZIONI MINERVA MEDICA

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.