Coronary artery bypass surgery and calcified aorta: off-pump strategy improves outcome

• Published in: The Thoracic and Cardiovascular Surgeon
• Main Authors: Therapidis, P, Aybek, T, Risteski, P, Zierer, A, Dogan, S, Detho, F, Moritz, A
• Format: Conference Proceeding
• Language: German
• Published: 18.01.2005
• ISSN: 0171-6425; 1439-1902
• DOI: 10.1055/s-2005-862135

Objectives: Calcified aorta increases the mortality and morbidity associated with conventional coronary artery bypass grafting (CABG). Several operative strategies have been proposed in order to avoid the complications related to manipulation of the calcified aorta. In this paper, we present our results from CABG in patients with calcified aorta. Material and Methods: Since January 2000, 53 patients (34 women, mean age 72±7 years) with coronary artery disease underwent surgical revascularization. 39 patients had unclampable porcelain aorta. Most common comorbidity was peripheral arterial disease (55%) followed by chronic obstructive pulmonary disease (34%), chronic renal failure (26%) and diabetes mellitus (13%), for a Euroscore of 8.4±4.2. Results: Seventeen patients underwent off-pump coronary artery bypass grafting and another seventeen were operated on-pump without aortic cross-clamping. Six patients required circulatory arrest and replacement of the ascending aorta. The rest underwent conventional operation and single clamp technique. In-Hospital mortality was 17%, more pronounced in those operated on with cardiopulmonary bypass (30.4%) than those operated off-pump (5.8%). Neurologic complications occurred in 4%. Actuarial survival at 36 months was 78±9% in off pump group and 64±11% in on-pump group (p<0.01). Conclusions: Patients with calcified aorta undergoing coronary revascularization have higher perioperative mortality and morbidity. Off pump strategy with avoidance of any manipulation of the ascending aorta may offer better outcome.