Background. Improved techniques in cerebral and myocardial protection
have made replacement of the chronically aneurysmal ascending thoracic
aorta a safe and effective procedure. We hypothesized that patients w
ith severe ascending or aortic arch atherosclerosis were at greater ri
sk for operative complications during ascending aortic replacement bec
ause of the diffuse nature of their atherosclerotic process. Methods.
We retrospectively analyzed the records of 17 patients who received as
cending aortic replacement during elective coronary artery bypass graf
ting (CABG) because of the intraoperative finding of severe atheroscle
rosis. All 17 patients underwent tube graft replacement of the ascendi
ng aorta under hypothermic circulatory arrest and retrograde cerebral
perfusion before coronary artery bypass grafting. The outcomes for the
se patients were compared with those of a control group of 89 consecut
ive patients who underwent replacement for ascending thoracic aortic a
neurysm. Results. The hospital mortality rate for replacement of the a
scending thoracic aorta for severe atherosclerosis was 23.5% (4/17) ve
rsus 2.25% (2 of 89) for the control group (p = 0.006). The incidence
of cerebrovascular accident in the atherosclerotic group was 17.6% (3/
17) and 3.37% (3/89) for the control group (p = 0.051). Nine of 17 ath
erosclerotic patients (52.9%) had operative morbidity. Only 20.2% (18
of 89) of the control patients had nonfatal postoperative complication
s. Conclusions. The severely atherosclerotic ascending aorta is a mark
er of diffuse atherosclerosis. Despite improved techniques of myocardi
al and cerebral protection, we have been unable to duplicate our succe
ss with ascending thoracic aneurysm repair. Preoperative screening of
the ascending aorta by chest computed tomography may be appropriate in
select high-risk patients to determine operability. (C) 1998 by The S
ociety of Thoracic Surgeons.