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Ann Thorac Surg 1999;67:986-988
© 1999 The Society of Thoracic Surgeons

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Original Articles

Management of porcelain aorta during coronary artery bypass grafting

^a Department of Cardiac Surgery, University of Lübeck, Lübeck, Germany

Accepted for publication September 6, 1998.

Address reprint requests to Dr Leyh, Department of Cardiac Surgery, Medical-University of Lübeck, Ratzeburger Allee 160 a, 23538 Lübeck, Germany

Background. Patients with porcelain aorta carry a high risk of systemic embolism during coronary artery bypass grafting. No currently proposed surgical approach avoids manipulation of the heavily calcified ascending aorta. A novel surgical approach avoiding manipulation of the porcelain aorta was evaluated with regard to its efficacy in prevention of atheroemboli.

Methods. The following surgical protocol was performed in 23 patients with porcelain aorta: (1) arterial cannulation of the axillary artery, (2) hypothermic fibrillatory arrest for performance of the distal anastomosis, and (3) construction of the proximal anastomosis to the inominate artery or to a disease-free area of the ascending aorta during hypothermic circulatory arrest.

Results. The postoperative course was uneventful in all patients. No patient experienced a cerebrovascular accident or visceral organ injury as a result of atheroemboli.

Conclusions. The proposed surgical approach is safe and reliable in patients with porcelain aorta and has the potential to reduce the prevalence of stroke and systemic embolization associated with coronary artery bypass grafting in patients with porcelain aorta.

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