Popoff G, Diaz F, Kreitmann P, Lena P, Durand P, Schmitt R
Service de chirurgie cardiaque, Institut Arnault-Tzanck, Saint-Laurent-du-Var.
Arch Mal Coeur Vaiss. 1992 Apr;85(4):429-33.
A massively calcified ascending aorta which may make aortic clamping impossible, is a major obstacle to coronary revascularisation surgery. The aim of this study was to demonstrate that by the use of certain technical modifications, these patients can be treated even in multivessel disease. In the author's experience, two patients with this condition underwent complete revascularisation with a good surgical result controlled by angiography. The sites of arterial cannulation were the aortic arch in one case, the brachiocephalic artery and the common femoral artery in the other case. The ascending aorta was not clamped in either patient or used as the origin of the coronary bypass grafts. Myocardial protection was performed by systemic cooling with ventricular fibrillation without cardioplegia. The feasibility of these methods has led to the suggestion of a classification of the aortic wall according to peroperative palpation. This classification would provide indications for the use of technical modifications not only in extreme cases of aortic calcification but also in patients with severe atherosclerotic changes at high neurological risk; it would not, however, interfere with the classical technique of revascularisation.
严重钙化的升主动脉可能导致无法进行主动脉钳夹，这是冠状动脉血运重建手术的主要障碍。本研究的目的是证明，通过使用某些技术改进，即使是多支血管病变的患者也能得到治疗。根据作者的经验，两名患有这种情况的患者接受了完全血运重建，手术结果良好，血管造影证实了这一点。动脉插管部位，一例为主动脉弓，另一例为头臂动脉和股总动脉。两名患者均未钳夹升主动脉，也未将其用作冠状动脉搭桥移植物的起点。通过全身降温诱导心室颤动而不使用心脏停搏液进行心肌保护。这些方法的可行性促使人们建议根据术中触诊对主动脉壁进行分类。这种分类不仅可为极端主动脉钙化病例，也可为具有高神经风险的严重动脉粥样硬化改变患者提供技术改进的使用指征；然而，它不会干扰经典的血运重建技术。
