Genoni M, Lachat M, Schmidli J, Turina M
Clinic for Cardiovascular Surgery, University Hospital, Zurich, Switzerland.
J Cardiovasc Surg (Torino). 1998 Dec;39(6):825-7.
Especially among elderly patients embolisms originating from atheromatous plaques in the ascending aorta are responsible for cardiac and cerebral events during coronary bypass surgery. Unfortunately smooth atheromatous degeneration of the aorta often can not be detected even by transoesophageal echocardiography.
In four patients with unexpected atheromatous material of the punched ascending aorta the so called "wash out technique" was performed. A side-to-end anastomosis between a segment of vein and the partially clamped ascending aorta was performed. For several minutes the ascending aorta was left to bleed through the venous stump. Without further manipulation of the ascending aorta the coronary bypass graft was completed by an end-to-end anastomosis between the venous stump and the venous graft. Oral anticoagulation in combination with a low dose platelet antiaggregation drug was given for at least one year.
All patients had an uncomplicated postoperative course, especially with regard to neurological damage or ECG changes.
In patients with unexpected atheromatous pathology of the ascending aorta the "wash out technique" of coronary artery bypass grafting minimises direct embolisation into the cardiac area perfused by the new bypass grafts.
尤其是在老年患者中，升主动脉粥样斑块形成的栓子是冠状动脉搭桥手术期间心脏和脑部事件的原因。不幸的是，即使通过经食管超声心动图检查，通常也无法检测到主动脉的平滑粥样变性。
对4例升主动脉穿刺时意外发现粥样物质的患者实施了所谓的“冲洗技术”。在一段静脉与部分钳夹的升主动脉之间进行端对端吻合。让升主动脉通过静脉残端出血几分钟。在未对升主动脉进行进一步操作的情况下，通过静脉残端与静脉移植物之间的端对端吻合完成冠状动脉搭桥移植。联合使用口服抗凝药和低剂量血小板抗聚集药物至少一年。
所有患者术后过程均无并发症，尤其是在神经损伤或心电图改变方面。
对于升主动脉出现意外粥样病变的患者，冠状动脉搭桥术的“冲洗技术”可将新的搭桥移植物灌注的心脏区域发生直接栓塞的情况降至最低。
