Extending the boundaries of no-touch aorta technique usage for coronary artery bypass grafting in patients with diseased ascending aorta.

AIM: Atherosclerosis of the ascending aorta is a leading cause of cerebrovascular accidents (CVA) in patients who undergo coronary artery bypass grafting (CABG). However, the ascending aorta is considered untouchable only in cases of severe calcification. The aim of this study is to evaluate the effect of the no-touch aorta technique (NAT) on morbidity and mortality with an extension of indication to any degree of atherosclerotic disease is detected on the ascending aorta. METHODS: From March 2001 to March 2006, data were prospectively collected from 101 patients with ascending aorta atherosclerosis who underwent either on- or off-pump CABG with NAT. Demographic data from these 101 patients were compared with those of 1 473 patients who underwent conventional CABG with aortic cross-clamping during the same time period. All preoperative variables were assessed with stepwise logistic regression to determine predictors of ascending aortic disease. RESULTS: Age, hypertension, hyperlipidemia, peripheral vascular disease, EuroSCORE and unstable and redo rates were significantly higher in the NAT group than in the control group (P<0.05). Logistic regression analysis of preoperative variables for all 1 574 cases identified age, peripheral vascular disease, history of smoking, EuroSCORE, and reoperation as independent predictors of atherosclerotic disease of the ascending aorta. No operative or hospital CVA occurred in the study group. Hospital mortality was observed in 2 (1.9%) patients. During the follow-up period of 27.9 +/- 13 months, no patient was re-admitted with angina recurrence or CVA. CONCLUSION: Any degree of atherosclerotic disease on the ascending aorta can potentially cause CVA upon manipulation during CABG. Use of CABG with NAT to eliminate the risk of CVA is associated with low rates of morbidity, stroke and mortality during hospital stay and at mid-term follow-up.

A case of truncus arteriosus type II.

A case of truncus arteriosus type II is reported. Truncus arterious is an uncommon congenital cardiac defect where a single great vessel exits the heart. Truncus arteriosus is usually fatal, if untreated. This defect occurs when the conus arteriosus and the truncus divide erroneously in the embryo. Palliative surgery in truncus arteriosus has been unsuccessful. Pulmonary banding has been tried and was ineffective and usually fatal. We operated on a nine-month-old (6200 g) male infant with a type II (Edwards-Collett) defect and a large ventricular septal defect. The pulmonary artery average pressure was 51 mmHg. We performed a cardiopulmonary bypass in the usual manner. Pulmonary arteries were resected from the truncal root, and primary end-to-end anastomosis of the truncal root to the ascending aorta was performed. Right ventricle to pulmonary artery continuity was provided using a valveless Gore-Tex graft. We lost our patient due to intractable pulmonary hypertension on the first postoperative day.