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Ann Thorac Surg 1986;41:293-296
© 1986 The Society of Thoracic Surgeons

Articles

Prevention of Neurological Injury during Myocardial Revascularization in Patients with Calcific Degenerative Aortic Disease

R.W. Landymore, M.D., F.R.C.S.C.*, C.E. Kinley, M.D., F.R.C.S.C., D.A. Murphy, M.D., F.R.C.S.C., J.A. Sullivan, M.D., F.R.C.S.C.

From the Department of Surgery, Division of Thoracic and Cardiovascular Surgery, Dalhousie University, Halifax, Nova Scotia, Canada

Accepted for publication May 28, 1985.

* Address reprint requests to Dr. Landymore, Room 3065, R.C. Dickson Centre, Victoria General Hospital, Halifax, Nova Scotia, Canada B3H 2Y9

Neurological injury following myocardial revascularization may result from embolization of atheromatous debris from the diseased ascending thoracic aorta. Eight patients with calcified aortas who underwent elective myocardial revascularization suffered major strokes as a result of manipulation and clamping of the diseased ascending aorta during a 30-month period before July, 1981. Computerized axial tomography scans demonstrated multiple cerebral infarctions in each patient. Six patients never regained consciousness and died as a result of neurological injury; 2 patients regained consciousness but were left with major neurological deficits. Later, 21 patients with calcific aortic degenerative disease underwent a specific operative protocol, designed to prevent neurological injury during elective myocardial revascularization. All 21 patients recovered without neurological complications. Specific attention to operative technique allowed this difficult group of patients with incapacitating angina and calcific degenerative aortic disease to have the benefit of coronary bypass.




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A. J. Baker, B. Naser, M. Benaroia, and C. D. Mazer
Cerebral microemboli during coronary artery bypass using different cardioplegia techniques
Ann. Thorac. Surg., May 1, 1995; 59(5): 1187 - 1191.
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