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Journal of Cardiothoracic Surgery

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Open Access 01-12-2013 | Research article

Extraanatomical coronary artery bypass grafting in patients with severely atherosclerotic (Porcelain) aorta

Authors: Gokce Sirin, Kamil Sarkislali, Murat Konakci, Ergun Demirsoy

Published in: Journal of Cardiothoracic Surgery | Issue 1/2013

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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.

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Title: Extraanatomical coronary artery bypass grafting in patients with severely atherosclerotic (Porcelain) aorta
Authors: Gokce Sirin
Kamil Sarkislali
Murat Konakci
Ergun Demirsoy
Publication date: 01-12-2013
Publisher: BioMed Central
Published in: Journal of Cardiothoracic Surgery / Issue 1/2013
Electronic ISSN: 1749-8090
DOI: https://doi.org/10.1186/1749-8090-8-86

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