Uyar Ibrahim, Demir Tolga, Polat Adil, Bahceci Fatma, Isik Omer
Department of Cardiovascular Surgery, JFK Hospital, Istanbul, Turkey.
J Card Surg. 2013 May;28(3):228-32. doi: 10.1111/jocs.12112.
Atheromatous plaques of the ascending aorta are one of the most important risk factors for postoperative mortality and morbidity in coronary artery bypass grafting (CABG). We have retrospectively analyzed the results of proximal anastomoses constructed on the innominate artery in patients with calcific atheromatous plaques (CAP) in their ascending aorta detected intraoperatively.
This study is a retrospective review of 16 consecutive patients who underwent CABG operations and had CAP on their ascending aorta between November 2006 and June 2009. The atheromatous lesions were detected intraoperatively and the operation plan was changed to off-pump surgery. All the proximal anastomoses were made on the innominate artery, left internal thoracic artery (LITA) or the other saphenous vein grafts (SVG). Thirteen patients were male and three were female with a mean age of 63.7 ± 5.3 (ranged, 53-71) years.
A total of 56 distal anastomoses (3.5 per patient) and 25 proximal anastomoses on the innominate artery were performed. Of the 16 patients, seven (43.7%) had received a sequential SVG; two (12.5%) patients, sequential LITA graft; and one (6.25%) patient sequential SVG and LITA graft. One of the proximal anastomoses was performed on the SVG in four patients (25%) and on the LITA graft in one patient (6.2%). One patient (6.2%) died due to cerebrovascular morbidity. No other complications were observed.
The innominate artery is an alternative site for proximal anastomoses in patients with calcific atheromatous aorta.
升主动脉粥样斑块是冠状动脉旁路移植术（CABG）术后死亡率和发病率的最重要危险因素之一。我们回顾性分析了术中发现升主动脉有钙化粥样斑块（CAP）的患者在无名动脉上进行近端吻合的结果。
本研究是对2006年11月至2009年6月期间连续16例行CABG手术且升主动脉有CAP的患者进行的回顾性研究。术中发现粥样病变，手术计划改为非体外循环手术。所有近端吻合均在无名动脉、左乳内动脉（LITA）或其他大隐静脉移植物（SVG）上进行。13例患者为男性，3例为女性，平均年龄63.7±5.3（范围53 - 71）岁。
共进行了56次远端吻合（每位患者3.5次）和25次无名动脉近端吻合。16例患者中，7例（43.7%）接受了序贯SVG；2例（12.5%）患者接受了序贯LITA移植物；1例（6.25%）患者接受了序贯SVG和LITA移植物。4例患者（25%）的近端吻合在SVG上进行，1例患者（6.2%）的近端吻合在LITA移植物上进行。1例患者（6.2%）因脑血管疾病死亡。未观察到其他并发症。
对于有钙化粥样硬化主动脉的患者，无名动脉是近端吻合的替代部位。
