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Ann Thorac Surg 1999;67:457-461
© 1999 The Society of Thoracic Surgeons

Original Articles

Complete thromboendarterectomy of the calcified ascending aorta and aortic arch

Paul R. Vogt, MDa, Markus Hauser, MDb, Urs Schwarz, MDc, Rolf Jenni, MDd, Mario L. Lachat, MDa, Gregor Zünd, MDa, Rolf W. Schüpbach, MDe, Daniel Schmidlin, MDe, Marko I. Turina, MDa

a Clinic for Cardiovascular Surgery, University Hospital, Zurich, Switzerland
b Institute for Diagnostic Radiology, University Hospital, Zurich, Switzerland
c Department of Neurology, University Hospital, Zurich, Switzerland
d Division of Echocardiography, University Hospital, Zurich, Switzerland
e Clinic for Cardiovascular Anesthesia, University Hospital, Zurich, Switzerland

Accepted for publication July 23, 1998.

Address reprint requests to Dr Vogt, Clinic for Cardiovascular Surgery, University Hospital, Rämistr. 100, CH-8091 Zurich, Switzerland

Background. Arteriosclerotic plaques of the ascending aorta and transverse arch increase the operative risk of cardiac operations and are strong predictors for late cerebrovascular events.

Methods. Twenty-two patients, mean age 68 ± 6 years (range, 55 to 77 years), with grade IV + V plaques of the ascending aorta and transverse arch underwent coronary artery bypass grafting (n = 21) and aortic valve replacement (n = 8). Cerebrovascular emboli from unknown sources were found preoperatively in 8 patients (36%). All were in sinus rhythm. Complete thromboendarterectomy of the ascending aorta and transverse arch was performed during hypothermic circulatory arrest. After 21 ± 12 months (range, 4 to 44 months), magnetic resonance imaging and transthoracic echocardiography of endarterectomized vessels was performed.

Results. There was one perioperative death (4.5%), one early (4.5%), and one late (4.7%) adverse neurologic event. Follow-up examinations revealed normal diameters of the endarterectomized aorta.

Conclusions. For patients with grade IV + V plaques, thromboendarterectomy of the ascending aorta and transverse arch can be performed with an acceptable surgical risk and a low recurrence rate for cerebrovascular events. Dilatation of the endarterectomized aorta was not observed.


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