| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Ann Thorac Surg 1986;41:27-35
© 1986 The Society of Thoracic Surgeons
From the Division of Cardiothoracic Surgery, Department of Surgery, New York University Medical Center, New York, NY
* Address reprint requests to Dr. Baumann, Room 532, CME Bldg, 520 First Ave, New York, NY 10016
Calcification of the ascending aorta and transverse arch significantly increases morbidity and may compromise the completeness of cardiac surgical procedures. Several stratagems have been suggested to reduce the risk, but for some patients this finding is still associated with a devastating outcome, irrespective of the technique employed. Thirteen patients (7 men and 6 women with a mean age of 66 years) with extensive calcification in the ascending aorta and transverse arch underwent cardiopulmonary bypass (CPB). The presence of calcification was known prior to CPB in 12 patients and noted after cross-clamping of the aorta in 1 patient. Special techniques for cannulation of the ascending aorta or arch were undertaken in 12 patients; 1 patient required groin cannulation. In 12 patients CPB with gradual core cooling to 18°C was done, during which time no manipulation of the aorta was allowed. Circulatory arrest was then initiated for 3.5 to 12 minutes. The aorta was opened widely during this time to remove ulcerated plaques and friable debris, and to locate a safe place for aortic occlusion. All patients recovered without neurological complications. In 1 patient, in whom occipital lobe infarcts developed, calcification was discovered after the aorta had been cross-clamped and necessitated subsequent endarterectomy of the ascending aorta and transverse arch. It is recommended that this hazardous finding be treated as follows: (1) selected cannulation of the ascending aorta or transverse arch with a long cannula so that its tip is distal to the left subclavian artery; (2) profound core cooling and circulatory arrest; (3) visual inspection of the aorta with removal of hazardous debris and preparation of a site for aortic occlusion; and (4) consideration given to doing the entire procedure with cross-clamping because of the local aortic condition.
This article has been cited by other articles:
|
|
 |
|
  B. Zingone, E. Rauber, G. Gatti, A. Pappalardo, B. Benussi, G. Forti, U. Tognolli, and M. Gabrielli Diagnosis and management of severe atherosclerosis of the ascending aorta and aortic arch during cardiac surgery: focus on aortic replacement Eur J Cardiothorac Surg, June 1, 2007; 31(6): 990 - 997. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Y. P. Liew and J. R Bartholomew Atheromatous embolization Vascular Medicine, November 1, 2005; 10(4): 309 - 326. [Abstract] [PDF]
|
|
|
|
 |
|
 L. N. Girardi, K. H. Krieger, C. A. Mack, and O. W. Isom No-Clamp Technique for Valve Repair or Replacement in Patients With a Porcelain Aorta Ann. Thorac. Surg., November 1, 2005; 80(5): 1688 - 1692. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A A Albert, C J Beller, B Arnrich, J A Walter, U P Rosendahl, A Hetzel, H Priss, and J Ennker Is there any impact of the shape of aortic end-hole cannula on stroke occurrence? Clinical evaluation of straight and bent-tip aortic cannulae Perfusion, December 1, 2002; 17(6): 451 - 456. [Abstract] [PDF]
|
|
|
|
|
|
A. Gerdes, T. Hanke, and H.-H Sievers In vitro hydrodynamics of the Embol-X cannula Perfusion, March 1, 2002; 17(2): 153 - 156. [Abstract] [PDF]
|
|
|
|
 |
|
 A. M. Gillinov, B. W. Lytle, V. Hoang, D. M. Cosgrove, M. K. Banbury, P. M. McCarthy, J. F. Sabik, G. B. Pettersson, N. G. Smedira, and E. H. Blackstone The atherosclerotic aorta at aortic valve replacement: Surgical strategies and results J. Thorac. Cardiovasc. Surg., November 1, 2000; 120(5): 957 - 965. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Trehan, M. Mishra, R. R. Kasliwal, and A. Mishra Reduced neurological injury during CABG in patients with mobile aortic atheromas: a five-year follow-up study Ann. Thorac. Surg., November 1, 2000; 70(5): 1558 - 1564. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Gaudino, F. Glieca, F. Alessandrini, N. Luciani, C. Cellini, C. Pragliola, and G. Possati The Unclampable Ascending Aorta in Coronary Artery Bypass Patients : A Surgical Challenge of Increasing Frequency Circulation, September 26, 2000; 102(13): 1497 - 1502. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Gerdes, E. Joubert-Hubner, K. Esders, and H.-H. Sievers Hydrodynamics of aortic arch vessels during perfusion through the right subclavian artery Ann. Thorac. Surg., May 1, 2000; 69(5): 1425 - 1430. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Bonatti, H. Hangler, D. Oturanlar, L. Posch, L. C. Muller, W. Voelckel, B. Schwarz, and G. Bodner Beating heart axillocoronary bypass for management of the untouchable ascending aorta in coronary artery bypass grafting Eur J Cardiothorac Surg, November 1, 1999; 16(Supplement_2): S18 - S23. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. A. Ozatik, K. M. Vural, E. Sener, and O. Tasdemir Epiaortic Ultrasound: Aortic Screening in Coronary Revascularization Asian Cardiovascular and Thoracic Annals, September 1, 1999; 7(3): 168 - 172. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. G. Leyh, C. Bartels, A. Notzold, and H.-H. Sievers Management of porcelain aorta during coronary artery bypass grafting Ann. Thorac. Surg., April 1, 1999; 67(4): 986 - 988. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. M. Murkin Strategies and Techniques for Neuroprotection in Coronary Artery Surgery Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 1999; 3(1): 4 - 8. [Abstract] [PDF]
|
|
|
|
|
|
C. W. Hogue JR, B. Barzilai, and V. G. Davila-Roman Stroke Reduction: Diagnosis and Management of the Atherosclerotic Ascending Aorta During Cardiac Surgery Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 1999; 3(1): 17 - 24. [Abstract] [PDF]
|
|
|
|
|
|
A. Khaki, P. S. Ravichandran, S. Kelly, H. L. Gately, A. Starr, and H. S. Floten Extended Aortic Arch Atherectomy Ann. Thorac. Surg., January 1, 1998; 65(1): 255 - 255. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Ogino, Y. Ueda, K. Morioka, K. Matsubayashi, and T. Nomoto Mitral Valve Repair in a Patient With Severe Porcelain Aorta Ann. Thorac. Surg., October 1, 1997; 64(4): 1179 - 1181. [Abstract] [Full Text]
|
|
|
|
|
|
L. Shore-Lesserson and S. N. Konstadt Aortic Atherosclerosis: Should We Bother to Look for It? Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 1997; 1(1): 39 - 48. [PDF]
|
|
|
|
|
|
R. S. D'Agostino, L. G. Svensson, D. J. Neumann, H. H. Balkhy, W. A. Williamson, and D. M. Shahian Screening Carotid Ultrasonography and Risk Factors for Stroke in Coronary Artery Surgery Patients Ann. Thorac. Surg., December 1, 1996; 62(6): 1714 - 1723. [Abstract] [Full Text]
|
|
|
|
|
|
L. G. Svensson, J. Sun, H. A. Cruz, and D. M. Shahian Endarterectomy for Calcified Porcelain Aorta Associated With Aortic Valve Stenosis Ann. Thorac. Surg., January 1, 1996; 61(1): 149 - 152. [Abstract] [Full Text]
|
|
|
|
|
|
D. Damodar Reddy, H. Storm Floten, and H. L. Gately CABG in calcified aorta under circulatory arrest Ann. Thorac. Surg., June 1, 1995; 59(6): 1571 - 1573. [Abstract] [PDF]
|
|
|
|
|
|
E. A. Grossi, M. S. Kanchuger, D. S. Schwartz, D. E. McLoughlin, M. LeBoutillier III, G. H. Ribakove, K. E. Marschall, A. C. Galloway, and S. B. Colvin Effect of cannula length on aortic arch flow: Protection of the atheromatous aortic arch Ann. Thorac. Surg., March 1, 1995; 59(3): 710 - 712. [Abstract] [PDF]
|
|
|
|
|
|
A. T. Culliford The atherosclerotic ascending aorta and transverse arch: A new technique to prevent cerebral injury during bypass: Experience with 13 patients Ann. Thorac. Surg., April 1, 1994; 57(4): 1051 - 1051. [Abstract] [PDF]
|
|
|
|
|
|
A. C. Beall, J. W. Jones, G. A. Guinn, L. G. Svensson, and C. Nahas Cardiopulmonary bypass in patients with previously completed stroke Ann. Thorac. Surg., June 1, 1993; 55(6): 1383 - 1385. [Abstract] [PDF]
|
|
|
|
|
|
G. H. Ribakove, E. S. Katz, A. C. Galloway, E. A. Grossi, R. A. Esposito, F. G. Baumann, I. Kronzon, and F. C. Spencer Surgical implications of transesophageal echocardiography to grade the atheromatous aortic arch Ann. Thorac. Surg., May 1, 1992; 53(5): 758 - 763. [Abstract] [PDF]
|
|
|
|
|
|
P. S. Peigh, V. J. DiSesa, J. J. Collins Jr, and L. H. Cohn Coronary bypass grafting with totally calcified or acutely dissected ascending aorta Ann. Thorac. Surg., January 1, 1991; 51(1): 102 - 104. [Abstract] [PDF]
|
|
|
|
|
|
H. Ohteki, T. Itoh, M. Natsuaki, N. Minato, and H. Suda Intraoperative ultrasonic imaging of the ascending aorta in ischemic heart disease Ann. Thorac. Surg., October 1, 1990; 50(4): 539 - 542. [Abstract] [PDF]
|
|
|
|
|
|
A. C. Galloway, S. B. Colvin, E. A. Grossi, F. G. Baumann, Y. P. Sabban, R. Esposito, G. H. Ribakove, A. T. Culliford, J. N. Slater, E. Glassman, et al. Ten-year experience with aortic valve replacement in 482 patients 70 years of age or older: Operative risk and long-term results Ann. Thorac. Surg., January 1, 1990; 49(1): 84 - 93. [Abstract] [PDF]
|
|
|
|
|
|
H. Nishida, R. K. Grooters, A. A. Yeager, H. Soltanzadeh, K. C. Thieman, and R. F. Schneider Carotid and aortic arch endarterectomy using hypothermic arrest with coronary bypass Ann. Thorac. Surg., December 1, 1989; 48(6): 865 - 866. [Abstract] [PDF]
|
|
|
|
|
|
W. G. Marshall Jr, B. Barzilai, N. T. Kouchoukos, and J. Saffitz Intraoperative Ultrasonic Imaging of the Ascending Aorta Ann. Thorac. Surg., September 1, 1989; 48(3): 339 - 344. [Abstract] [PDF]
|
|
|
|
|
|
N. L. Mills and C. T. Everson Rigt gastroepiploic artery: A third arterial conduit for coronary artery bypass Ann. Thorac. Surg., May 1, 1989; 47(5): 706 - 711. [Abstract] [PDF]
|
|
|
|
|
|
J. S. Coselli, E. S. Crawford, A. C. Beall Jr., E. M. Mizrahi, K. R. Hess, and V. M. Patel Determination of Brain Temperatures for Safe Circulatory Arrest during Cardiovascular Operation Ann. Thorac. Surg., June 1, 1988; 45(6): 638 - 642. [Abstract] [PDF]
|
|
|
|
|
|
R. W. Landymore, C. E. Kinley, D. A. Murphy, and J. A. Sullivan Prevention of Neurological Injury during Myocardial Revascularization in Patients with Calcific Degenerative Aortic Disease Ann. Thorac. Surg., March 1, 1986; 41(3): 293 - 296. [Abstract] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
