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The Annals of Thoracic Surgery, Vol 41, 27-35, Copyright © 1986 by The Society of Thoracic Surgeons
AT Culliford, SB Colvin, K Rohrer, FG Baumann and FC Spencer
Calcification of the ascending aorta and transverse arch significantly
increases morbidity and may compromise the completeness of cardiac surgical
procedures. Several stratagems have been suggested to reduce the risk, but
for some patients this finding is still associated with a devastating
outcome, irrespective of the technique employed. Thirteen patients (7 men
and 6 women with a mean age of 66 years) with extensive calcification in
the ascending aorta and transverse arch underwent cardiopulmonary bypass
(CPB). The presence of calcification was known prior to CPB in 12 patients
and noted after cross-clamping of the aorta in 1 patient. Special
techniques for cannulation of the ascending aorta or arch were undertaken
in 12 patients; 1 patient required groin cannulation. In 12 patients CPB
with gradual core cooling to 18 degrees C was done, during which time no
manipulation of the aorta was allowed. Circulatory arrest was then
initiated for 3.5 to 12 minutes. The aorta was opened widely during this
time to remove ulcerated plaques and friable debris, and to locate a safe
place for aortic occlusion. All patients recovered without neurological
complications. In 1 patient, in whom occipital lobe infarcts developed,
calcification was discovered after the aorta had been cross-clamped and
necessitated subsequent endarterectomy of the ascending aorta and
transverse arch.(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
The atherosclerotic ascending aorta and transverse arch: a new technique to prevent cerebral injury during bypass: experience with 13 patients
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