A novel technique of coronary revascularization in porcelain aorta: Report of two cases

Abstract

Severe atherosclerosis of the distal ascending aorta increases the risk of intraoperative stroke during coronary artery bypass. More than one in situ arterial graft is required to avoid aortic manipulation during proximal anastomosis. The application of bilateral internal thoracic arteries is a good choice, but it also carries the risk of sternal wound complications. Using a composite graft constructed with a partially harvested in situ right internal thoracic artery graft and another vascular conduit prevents extreme ischemia of the sternum. This study describes the experience of successful coronary revascularization using bilateral internal thoracic arteries and modified with a composite graft in two patients with a severely atherosclerotic ascending aorta.

Extraanatomical coronary artery bypass grafting in patients with severely atherosclerotic (Porcelain) aorta

“…These include "no-touch" technique [10], single-clamp technique [14,26], placement of proximal saphenous vein (SV) grafts onto the internal mammary artery (IMA), onto the innominate artery [4,5,9,13,15], onto the axillary artery, [9,29] or onto the carotid artery [27,30,31], complete arterial revascularization with pedicle arterial grafts (ITA and right gastroepiploic artery) under hypothermic fibrillatory arrest that avoids clamping of the ascending aorta [10,13,32], replacement of the ascending aorta [24], aortic endarterectomy [17,19,33], patch aortoplasty, and arterial cannulation of the axillary artery [13,16,28]. Furthermore, coronary-coronary bypass on a beating heart (off-pump surgery) can be performed safely in patients with porcelain aorta [34].…”