MYOCARDIAL REVASCULARIZATION USING THE NO-TOUCH TECHNIQUE, WITH MILD SYSTEMIC HYPOTHERMIA, IN PATIENTS WITH A CALCIFIED ASCENDING AORTA

Modifications in the standard technique for coronary artery bypass gra fting are recommended in presence of a calcified ascending aorta, to a void clamp injury or atheroembolism. Between January 1991 and August 1 994, we used a ''no-touch'' technique in 18 patients undergoing myocar dial revascularization, who had a heavily calcified and atheroscleroti c ascending aorta. Their mean age was 76.1 years (range 63 to 82 years ). Cardiopulmonary bypass with mild systemic hypothermia (32 degrees C ) was employed in 16 patients; 2 other patients were operated upon wit hout cardiopulmonary bypass. The ''no-touch'' technique avoids all typ es of clamps in the aorta. No cardioplegia was given, and no grafts we re anastomosed to the aorta. Fifty-two distal anastomoses (mean: 2.9 p er patient) were performed, using 37 pedicled arterial grafts (22 inte rnal mammary and 15 gastroepiploic arteries), and 15 free grafts, whic h were anastomosed proximally to the internal mammary artery. There we re no postoperative cerebrovascular accidents. Three patients died (16 .7% overall mortality): 1 died of pneumonia, one patient with a large left ventricular aneurysm died in congestive heart failure, and one pa tient with associated aortic insufficiency died in low cardiac output. Our experience suggests that using pedicled arterial grafts for myoca rdial revascularization is safe and effective to avoid clamp injury or atheroembolism in patients with a calcified aorta. Deep hypothermia i s not necessary when using the ''no-touch'' technique.