Distribution of Thoracic Aortic Calcifications in Patients Undergoing Coronary Artery Bypass Grafting

Abstract

Background: In procedures involving surgical maneuvers such as cannulation, clamping, or proximal anastomosis where aortic manipulation is inevitable, a preliminary assessment of atherosclerotic plaques bears clinical significance. In the present study, our aim was to evaluate the frequency and distribution of aortic calcifications in patients undergoing coronary artery bypass grafting (CABG) surgery to propose a morphological classification system. Methods: A total of 443 consecutive patients with coronary artery disease were included in this study. Preoperative non-contrast enhanced computed tomography images, in-hospital follow-up data, and patient characteristics were retrospectively evaluated. Results: Whereas 33% of patients had no calcifications at any site in the aorta, 7.9%, 75.4%, and 16.7% had calcifications in the ascending aorta, aortic arch, and descending aorta, respectively. Focal small calcifications were the most common type of lesions in the ascending aorta (3.9%), whereas 9 patients (1.4%) had porcelain ascending aorta. We defined four types of patients with increasing severity and extent of calcifications. Conclusions: Based on the frequency and distribution of calcifications in the thoracic aorta, we propose a classification system from least to most severe for coronary artery disease patients who are candidates for CABG.

Atrial Fibrillation after Coronary Bypass Surgery? Is Epicardial Fat a Risk Factor?

“…Thoracic CT scan is performed in routine preoperative workup for each patient to evaluate vascular anomalies, thoracic masses, and, especially, aortic calcifications to avoid cerebral embolic events. 18 Patient characteristics, medical history, intraoperative variables, and postoperative outcomes were retrospectively collected. Patients with a history of persistent or paroxysmal AF, moderate or severe valve insufficiency (concomitant valve surgery), emergent CABG, heart failure (left ventricular [LV] EF < 50%), left atrium enlargement (>4.5 cm), ongoing dialysis, use of antiarrhythmic drugs (other than β-blockers), use of permanent pacemakers, systemic inflammatory disease, and treatment with corticosteroids or nonsteroidal anti-inflammatory drugs other than aspirin were excluded.…”

The brain‐before‐heart strategy for coronary artery bypass grafting in the severely atherosclerotic aorta: A single‐institution experience

“…Severe ascending aortic atherosclerosis (SAA) has been shown to be the most important predictor of stroke in coronary artery bypass grafting (CABG) 1 . The increasing number of elderly patients undergoing surgical revascularization in recent years has brought greater attention to SAA in CABG, as atherosclerotic disease increases with age 2 . The underlying potential risk for athero‐embolic events is closely correlated with the severity of atherosclerosis in the ascending aorta and adds a considerable risk of spontaneous embolic strokes with diminished survival during the long‐term postoperative course 3 .…”

“… 1 The increasing number of elderly patients undergoing surgical revascularization in recent years has brought greater attention to SAA in CABG, as atherosclerotic disease increases with age. 2 The underlying potential risk for athero‐embolic events is closely correlated with the severity of atherosclerosis in the ascending aorta and adds a considerable risk of spontaneous embolic strokes with diminished survival during the long‐term postoperative course. 3 Surgical manipulation of the ascending aorta during cardiac surgery procedures, and in particular the application and removal of the aortic cross‐clamp, is associated with the highest number of detectable emboli in the middle cerebral artery by Doppler ultrasound.…”

Aortic Arch Calcification Is a Strong Predictor of the Severity of Coronary Artery Disease in Patients with Acute Coronary Syndrome

“…Arterial calcification has long been considered a complication of advanced atherosclerosis [4]. The aortic arch has been identified as the most vulnerable site for calcifications in the thoracic aorta [5]. Aortic arch calcification (AAC) is detectable on chest X-ray and accurately represents the magnitude of calcified change throughout the whole aorta [6].…”