A No-Touch Technique for Calcified Ascending Aorta during Coronary Artery Surgery.
(texas heart institute journal - 1998, vol 25/no:2: )
Summary: Despite improvements in cardiovascular surgery techniques over the years, the incidence of neurologic complications has not declined, and stroke remains a possible (and devastating) sequela to coronary artery surgery. In this report, we describe a moderate hypothermic fibrillatory arrest technique that avoids cross-clamping or otherwise touching the aorta; use of the internal thoracic arteries and the right gastroepiploic artery provides optimum revascularization and minimizes the risk of cerebrovascular accident. Over a 1-year period, we used the technique in 21 patients who had heavy calcifications of the ascending aorta. No hemodynamic problems, lower-limp ischemia, or neurologic complications were seen. Only 1 patient underwent reoperation (for bleeding), and another-whose revascularization was incompete-had high postoperative level of myocardial creatine kinase MB isoenzyme and a new Q wave, but no hemodynamic deterioration. This technique seems reasonable, because it appears to provide good myocardial protection and to reduce neurologic complications, without compromising myocardial revascularization.