ABSTRACT 35

Off-pump Coronary Artery Revascularization- Ideal Indication for Patients with Porcelain aorta and Calcification of Great Vessels

Hartmuth B. Bittner and Michael A. Savitt, Division of Cardiovascular Surgery, University of Minnesota, Minneapolis, Minnesota.

Patients with porcelain aorta and severe calcification of the great vessels are a challenging dilemma for the cardiovascular surgeon regarding bypass technique, choice of conduit, and selection of proximal anastomotic sites due to the high incidence of devastating thrombembolization and aortic injury. On the basis of these findings, modifications of standard cardiovascular techniques are mandatory in order to avoid manipulations of the aorta and to prevent the occurrence of atheroembolism. This is the first report of successful off-pump bypass grafting (OPCABG) in three patients with severely calcified ascending aorta and great vessels. Additionally one patient presented with subtotal aorto-bi-iliac stenoses and a history of previous stroke and right carotid endarterectomy. One patient had significant left main coronary artery stenosis in combination with total RCA occlusion.  All patients had post-infarct unstable angina and decreased ventricular function. OPCABG with “no-touch” of the aorta was performed through a median sternotomy. The left and/or right internal thoracic artery (LITA/RITA) was used for inflow in 2 cases. A composite saphenous vein-LITA conduit was used in one patient anastomosed proximally to the right common carotid artery. In all patients the distal anastomoses to the LAD, obtuse marginal branches, and PDA were performed by means of a commercially available cardiac stabilizer. The patients were extubated two hours after the operation, made subsequently an uneventful recovery. OPCABG and “no-touch” technique is the only strategy potentially capable of eliminating the risk of manipulation induced stroke in patients with atherosclerotic aorta.