Wash out technique for proximal anastomosis in atherosclerotic ascending aorta

Background. Especially among elderly patients embolisms originating from at heromatous plaques in the ascending aorta are responsible for cardiac and c erebral events during coronary bypass surgery. Unfortunately smooth atherom atous degeneration of the aorta often can not be detected even by transoeso phageal echocardiography. Methods. In four patients with unexpected atheromatous material of the punc hed ascending aorta the so called "wash out technique" was performed. A sid e-to-end anastomosis between a segment of vein and the partially clamped as cending aorta was performed. For several minutes the ascending aorta was le ft to bleed through the venous stump. Without further manipulation of the a scending aorta the coronary bypass graft was completed by an end-to-end ana stomosis between the venous stump and the venous graft. Oral anticoagulatio n in combination with a low dose platelet antiaggregation drug was given fo r at least one year. Results. All patients had an uncomplicated postoperative course, especially with regard to neurological damage or ECG changes. Conclusions. In patients with unexpected atheromatous pathology of the asce nding aorta the "wash out technique" of coronary artery bypass grafting min imises direct embolisation into the cardiac area perfused by the new bypass grafts.