Management of porcelain aorta during coronary artery bypass grafting

Background. Patients with porcelain aorta carry a high risk of systemic emb olism during coronary artery bypass grafting. No currently proposed surgica l approach avoids manipulation of the heavily calcified ascending aorta. A novel surgical approach avoiding manipulation of the porcelain aorta was ev aluated with regard to its efficacy in prevention of atheroemboli. Methods. The following surgical protocol was performed in 23 patients with porcelain aorta: (1) arterial cannulation of the axillary artery, (2) hypot hermic fibrillatory arrest for performance of the distal anastomosis, and ( 3) construction of the proximal anastomosis to the inominate artery or to a disease-free area of the ascending aorta during hypothermic circulatory ar rest. Results. The postoperative course was uneventful in all patients. No patien t experienced a cerebrovascular accident or visceral organ injury as a resu lt of atheroemboli. Conclusions. The proposed surgical approach is safe and reliable in patient s with porcelain aorta and has the potential to reduce the prevalence of st roke and systemic embolization associated with coronary artery bypass graft ing in patients with porcelain aorta. (Ann Thorac Surg 1999;67:986-8) (C) 1 999 by The Society of Thoracic Surgeons.