Coronary bypass grafting with totally calcified or acutely dissected ascending aorta.

From August 1984 through November 1988, 10 of 2,658 patients undergoing coronary artery bypass grafting had ascending aortic disease that was not amenable to proximal anastomoses for coronary bypass grafting. This was due to a calcified aorta in 6 and acute aortic dissection in 4. There were 5 male and 5 female patients with a mean age of 71 years. Cannulation site was the femoral artery in 5, ascending aorta in 3, and aortic arch in 2. Profound hypothermia and ventricular fibrillation, with no cross-clamp or cardioplegia, was used in 9 patients, and circulatory arrest in 1. In 8 patients a single internal mammary artery was used as the total inflow with a saphenous vein graft brought off the internal mammary artery to one or more distal left-sided coronary vessels. Bilateral internal mammary arteries were used in 2 other patients. Operative mortality was zero. There was one perioperative myocardial infarction and one transient stroke without sequelae. All patients have done well from 1 to 6 years postoperatively. These data support the use of internal mammary arteries as single or bilateral proximal conduits for other venoarterial bypass grafts when the aorta is extensively diseased either by calcification or dissection.