Leyh R G, Bartels C, Nötzold A, Sievers H H
Department of Cardiac Surgery, University of Lübeck, Germany.
Ann Thorac Surg. 1999 Apr;67(4):986-8. doi: 10.1016/s0003-4975(98)01370-8.
Patients with porcelain aorta carry a high risk of systemic embolism during coronary artery bypass grafting. No currently proposed surgical approach avoids manipulation of the heavily calcified ascending aorta. A novel surgical approach avoiding manipulation of the porcelain aorta was evaluated with regard to its efficacy in prevention of atheroemboli.
The following surgical protocol was performed in 23 patients with porcelain aorta: (1) arterial cannulation of the axillary artery, (2) hypothermic fibrillatory arrest for performance of the distal anastomosis, and (3) construction of the proximal anastomosis to the inominate artery or to a disease-free area of the ascending aorta during hypothermic circulatory arrest.
The postoperative course was uneventful in all patients. No patient experienced a cerebrovascular accident or visceral organ injury as a result of atheroemboli.
The proposed surgical approach is safe and reliable in patients with porcelain aorta and has the potential to reduce the prevalence of stroke and systemic embolization associated with coronary artery bypass grafting in patients with porcelain aorta.
瓷化主动脉患者在冠状动脉旁路移植术中发生全身栓塞的风险很高。目前尚无提议的手术方法可避免对严重钙化的升主动脉进行操作。我们评估了一种避免对瓷化主动脉进行操作的新型手术方法预防动脉粥样硬化栓子的疗效。
对23例瓷化主动脉患者实施了以下手术方案：（1）腋动脉插管；（2）低温颤动停搏以进行远端吻合；（3）在低温循环停搏期间构建至无名动脉或升主动脉无病变区域的近端吻合。
所有患者术后过程均顺利。没有患者因动脉粥样硬化栓子而发生脑血管意外或内脏器官损伤。
提议的手术方法在瓷化主动脉患者中安全可靠，有可能降低瓷化主动脉患者冠状动脉旁路移植术相关的中风和全身栓塞发生率。
