Coronary Artery Surgery in Patients with Severe Atherosclerosis of the Ascending Aorta

Belhhan AKPINAR, Mustafa GÜDEN, Bülent POLAT, Ertan SAĞBAŞ, İlhan SANİSOĞLU, Bingür SÖNMEZ, *Cemi DEMİROĞLU

Kadir Has Üniversitesi, Tıp Fakültesi, Florence Nightingale Hastanesi, İstanbul, Kalp Damar Cerrahisi Bölümü
^*Kardiyoloji Bölümü

Despite the improvements in cardiovascular surgery techniques over the years, the incidence of neurologic complications has not declined, and stroke remains a possible and devastating sequel to coronary artery surgery. A moderate hypothermic fibrillatory arrest technique that avoids cross-clamping or otherwise touching the aorta is described.

Over 2 years period, we used the technique in 23 patients who had heavy calcifications of the ascending aorta. Mean age was 65 ± 3 years. Cardiopulmonary bypass was instuted via femoral artery and right superior pulmonary vein. All patients were operated under moderate hypotermia (26-28 ºC) and ventricular fibrillation, using left and right internal thoracic artery, right gastroepiploic artery and the combination of these grafts. No clamp was no proximal anastomosis.

30 days mortality was 0. No hemodynamic problems, lower-limb ischemia, or neurologic complications were seen. Only 1 patient underwent reoperation for bleeding, and another whose revascularization was incomplete had a high postoperative level of myocardial creatine kinase MB isoenzyme and a new Q wave, but no hemodynamic deterioration.

This technique seems reasonable, because et appears to provide good myocardial protection and to reduce neurologic complications without compromising myocardial revascularization.

Keywords :

Viewed : 20433

Downloaded : 2823