Strategies for Multiple Coronary Artery Bypass in Patients with Calcified Ascending Aorta / 中国微创外科杂志

ABSTRACT

Objective To review the strategies for multiple coronary artery bypass in patients with calcified ascending aorta.Methods From June 2002 to December 2007,36 patients with multiple coronary artery disease and calcified ascending aorta underwent OPCAB without aortic side-bite clamping.The patients(28 males and 8 females) aged from 60 to 83 years with a mean of(69.1?6.7) years.Fifteen of the patients had a history of stroke.Coronary angiogram revealed that 3 patients had double vessels disease and the others had triple vessels disease,involving the left main stem in 14 cases.The left ventricular ejection fraction ranged from 0.32-0.69.Calcified ascending aortic plaque can be explored in 30 of the patients during operation while intra-operative transesophageal echocardiography indicated calcified aorta only in 28.No-touch technique was used in 22 patients either with LIMA as the only inflow and the saphenous vein grafts was anastomosed to the LIMA in 15 patients,or with bilateral internal mammary arteries as the only inflows in 7 patients.Proximal anastomotic device was employed in 14 patients to finish the proximal anastomosis of greater saphenous vein grafts without aortic side-biting clamping.Intra-operative graft flow meter was used to check the flow of grafts before chest closure. Results Totally 116 cases of distal anastomosis were performed in the 36 patients(2-5 in each,mean 3.2?0.9).The patients woke up from anesthesia in 2 to 22 hours.Intraoperative measuring of graft flow revealed satisfying blood flow in all the grafts.In the 15 patients with LIMA as the only inflow,the total graft flow in the main stem of LIMA was basically the sum of each connected grafts.Only one patient died after surgery,showing a mortality rate of 2.7%.Eight patients(26.7%) had transient atrial fibrillation after the operation,2 showed pulmonary infection,4 had chest fluid,1 showed infection of the incision at the lower limb.All the complications were cured.30 patients achieved a 6-to 60-month follow-up with a mean of(33.8?11.2) months.During the period,11 patients(37 grafts) were examined by angiography,which showed that all the grafts of LIMA to LAD and vein grafts were patent,except in two vein grafts,which were occluded in the diagnol branches. Conclusions In patients with remarkable ascending aortic calcification,OPCAB combined with aorta no-touch technique or proximal anastomosis device can effectively decrease the incidence of postoperative stroke.