An Alternative Technique of Proximal Anastomosis in Patients with an Atherosclerotic Ascending Aorta

2006 ◽  
Vol 9 (6) ◽  
pp. E846-E848 ◽  
Author(s):  
Noyan Temucin Ogus ◽  
Halide Ogus ◽  
Tekin Yildirim ◽  
Ozer Selimoglu ◽  
Murat Basaran
Keyword(s):  
Ascending Aorta ◽  
Alternative Technique ◽  
Proximal Anastomosis ◽  
Atherosclerotic Ascending Aorta

scholarly journals An evaluation of the long-term patency of the aortocoronary bypass graft anastomosed to a vascular prosthesis

2020 ◽  
Vol 58 (4) ◽  
pp. 832-838
Author(s):  
Ai Kawamura ◽  
Daisuke Yoshioka ◽  
Koichi Toda ◽  
Ryoto Sakaniwa ◽  
Shigeru Miyagawa ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Aortic Aneurysm ◽  
Thoracic Aortic Aneurysm ◽  
Vascular Prosthesis ◽  
Ascending Aorta ◽  
Graft Occlusion ◽  
Proximal Anastomosis ◽  
Left Circumflex Artery ◽  
Anastomosis Site

Abstract OBJECTIVES Although concomitant surgery for coronary artery disease (CAD) and thoracic aortic aneurysm is performed often, the long-term patency of the coronary artery bypass grafting (CABG) anastomosed to a vascular prosthesis has not been fully investigated. Here, we explored the long-term patency of the graft in comparison with the proximal anastomosis site on the native ascending aorta or vascular prosthesis. METHODS A total of 84 patients with concomitant CABG who underwent surgery for thoracic aortic aneurysm at 3 Osaka Cardiovascular Research Group institutes were retrospectively investigated for this study. The patency of 109 aortocoronary bypasses using saphenous vein grafts was evaluated with computed tomography angiography or coronary angiography, comparing the grafts anastomosed on the vascular prosthesis (group P, n = 75) to those anastomosed on the native ascending aorta (group N, n = 34). RESULTS During 45.9 ± 39.7 months follow-up, significantly worse patency of the grafts in group P was revealed when compared with those in group N (100% vs 77.6% in 12 months, 100% vs 52.7% in 36 months and 100% vs 31.6% in 57 months, log rank P < 0.001). The poor patency of the grafts was confirmed in each target lesions (left anterior descending artery: P = 0.050, right coronary artery: P = 0.045, left circumflex artery: P = 0.051) and regardless of the severities of the target coronary vessels (severe stenosis: P = 0.013, mild-to-moderate stenosis: P = 0.029). Furthermore, an analysis of graft occlusion risk factors using the univariate Cox proportional hazards model revealed that the proximal anastomosis site on the vascular prosthesis was the sole risk factor for graft occlusion (P < 0.001). CONCLUSIONS In the simultaneous surgery for CAD and thoracic aortic aneurysm, CABG design from vascular prosthesis to coronary artery should be avoided if possible, although further studies are warranted.

Coronary artery bypass grafting for patients with an atherosclerotic ascending aorta

2001 ◽  
Vol 49 (4) ◽  
pp. 195-200 ◽  
Author(s):  
Hitoshi Ogino ◽  
Yuichi Ueda ◽  
Takafumi Tahata ◽  
Takaaki Sugita ◽  
Junichiro Nishizawa ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Ascending Aorta ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Atherosclerotic Ascending Aorta

scholarly journals Management of the severely atherosclerotic ascending aorta during cardiac operations

1992 ◽  
Vol 103 (3) ◽  
pp. 453-462 ◽  
Author(s):  
Thomas H. Wareing ◽  
Victor G. Davila-Roman ◽  
Benico Barzilai ◽  
Suzan F. Murphy ◽  
Nicholas T. Kouchoukos
Keyword(s):  
Ascending Aorta ◽  
Cardiac Operations ◽  
Atherosclerotic Ascending Aorta

Assistive Techniques for Proximal Anastomosis in Minimally Invasive Coronary Artery Bypass Grafting

2017 ◽  
Vol 12 (3) ◽  
pp. 224-226 ◽  
Author(s):  
Keita Kikuchi ◽  
Yoshiki Endo
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Pulmonary Artery ◽  
Minimally Invasive ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Ascending Aorta ◽  
Bypass Grafting ◽  
Proximal Anastomosis ◽  
Artery Bypass Grafting

We introduce assistive techniques for proximal anastomosis in off-pump minimally invasive coronary artery bypass grafting (MICS CABG) to overcome difficult access to the ascending aorta in MICS CABG. An 8-cm left thoracotomy is made in the fifth intercostal space. ThoraTrak retractor (Medtronic Inc, Minneapolis, MN USA) is used to open the thoracotomy and is pulled to the cephalad and rightward direction toward to the ascending aorta. The pericardium is opened from the ascending aorta to the left ventricular apex and to the inferior vena cava. Two retraction sutures on the pericardial edge are used to laterally displace the heart. After dissecting between the ascending aorta and main pulmonary artery, the Octopus tissue stabilizer (Medtronic Inc, Minneapolis, MN USA), of which the suction tip is bent 60 degrees, is used to retract the pulmonary artery caudally. A flexible side-biting clamp (Vitalitec Inc.) is placed on the ascending aorta, and proximal anastomoses are handsewn on the ascending aorta. A total of 31 proximal anastomoses were completed with this technique between November 2013 and June 2015. All proximal anastomosis was completed without any difficulty. In MICS CABG, the technical challenges in proximal anastomosis due to difficult access to the aorta can be overcome safely by using this technique.

scholarly journals Large mural thrombus in the non-aneurysmal and non-atherosclerotic ascending aorta: a case report

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Xiaoyi Dai ◽  
Chengyao Ni ◽  
Wenzong Luo ◽  
Sihan Miao ◽  
Liang Ma
Keyword(s):  
Anterior Wall ◽  
Ascending Aorta ◽  
Preoperative Imaging ◽  
Uneventful Recovery ◽  
Surgical Removal ◽  
Mural Thrombus ◽  
Aortic Thrombus ◽  
Thrombotic Complications ◽  
Aorta Replacement ◽  
Atherosclerotic Ascending Aorta

Abstract Background The mural thrombus in the ascending aorta is rare, most of which are associated with aneurysm or atherosclerotic lesions, with high risks of causing catastrophic thrombotic events. A mural thrombus in the non-aneurysmal and non-atherosclerotic ascending aorta is exceptionally uncommon. Case presentation We reported a large mural thrombus in normal ascending aorta of an asymptomatic patient. Preoperative imaging confirmed the presence of the sessile thrombus located at the left anterior wall of ascending aorta. Given that it had the potential to cause fatal thrombotic complications, surgical removal and segment of ascending aorta replacement were executed. The patient had an uneventful recovery and discharged 14 days after surgery. Conclusions Anticoagulant is the therapeutic cornerstone of ascending aortic thrombus, but surgery should be performed aggressively when the thrombus is large or floating to avoid severe embolic complications or recurrence.

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