CABG: coronary artery bypass grafting, ITA: internal thoracic artery, GEA: gastroepiploic artery, IEA: inferior epigastic artery, LV: left ventricle,

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1 Coronary Artery Bypass Grafting in the Presence of Atherosclerotic Lesions in the Ascending Aorta Tadashi Isomura, Toru Satoh, Nobuhiko Hayashida, Hiroshi Maruyama, Kouichi Hisatomi*, Tatsuya Higashi, Kouichi Arinaga, Ikutaroh Akasu, Kenichi Kosuga and Shigeaki Aoyagi (Department of Surgery II, Kurume University Hospital Kurume, Japan and Department of Surgery II, Kagoshima University Hospital*, Kagoshima, Japan) The results and surgical techniques were studied in 59 patients who had atherosclerotic lesions in the ascending aorta. Arterial grafting (AG) and sequential grafting for coronary artery bypass grafting (CABG) was used in as many as possible cases and the number of distal anastomoses with AG was 1.3/patient (internal thoracic artery (ITA), 56 anastomoses for 50 patients; gastroepiploic artery (GEA),17; and inferior epigastric artery, 3). Calcification in the ascending aorta was noted in 26 patients and arterial cannulation was performed via the right axillary artery in 4 patients. Saphenous vein grafts were used for 51 patients and 30 of them required aortic reconstruction for proximal anastomosis. There were 2 hospital deaths (non-cardiac) and no neurological complications. It is difficult to perform CABG in the presence of atherosclerosis in the ascending aorta. However, the right axillary artery cannulation as the site of arterial cannulation and the use of sequential grafting, using ITA and GEA as the pedicled arterial conduits are useful to accomplish CABG in such patients. Neurological complication seems to be manufactured at a minimal level by cautious operative techniques. Jpn. J. Cardiovasc. Surg. 26: (1997)

2 CABG: coronary artery bypass grafting, ITA: internal thoracic artery, GEA: gastroepiploic artery, IEA: inferior epigastic artery, LV: left ventricle, MVR: mitral valve replacement, AVR: aortic valve replacement, ECC: extra coporeal circulation, Ao x-clamp: aorta cross clamp, F-F: femoro-femoral, F-P: femoro-popliteal.

ac. Surg. 59: 84-89, 1995. 7) Bar-El, Y. and Goor, D. A.: Clamping of the atherosclerotic ascending aorta during coronary artery bypass operations. J. Thorac. Car- diovasc. Surg. 104: 469-474, 1992.

6 ac. Surg. 59: 84-89, ) Bar-El, Y. and Goor, D. A.: Clamping of the atherosclerotic ascending aorta during coronary artery bypass operations. J. Thorac. Car- diovasc. Surg. 104: , ) Acinapura, A. J., Rose, D. M., Cunningham, J. N. et al.: Coronary artery bypass in septuagenarians: analysis of mortality and morbidity. Circulation 78 (Suppl. I): , ) Saloman, N. W., Page, U. S., Bigelow, J. C. et al.: Coronary artery bypass grafting in elderly patients: comparative results in a consecutive series of 469 patients older than 75 years. Thorac. Cardiovasc. Surg. 101: , ) Kolkka, R. and Hilberman, M.: Neurologic dysfunction following cardiac operation with low-flow, low-pressure cardiopulmonary by- J. Thorac. Cardiovasc. Surg. 79: , pass ) Ribakove, G. H., Katz, E. S., Galloway, A. C. et al.: Surgical implications of transesophageal echocardiography to grade the atheromatous aortic arch. Ann, Thorac. Surg. 53: , ) Barzilai, B., Marshall, W. G., Saffitz, J. E. et al.: Avoidance of embolic complications by 1) Coffey, C. E., Massey, E. W., Roberts, K. B. et ultrasonic characterization of the ascending aorta. Circulation 80 (Suppl. I): , ) Tobler, H. G. and Edward, J. E.: Frequence al.: National history of cerebral complication of coronary artery bypass graft surgery. Neurology. 33: , ) Gardner, T. J., Horneffer, P. J., Manolio, T. A. et al.: Stroke following coronary artery bypass grafting: a ten-year study. Ann. Thorac. Surg. 40: , ) Gonzalez-Scarano, F. and Hurtig, H. I.: Neurologic complications of coronary artery bypass grafting: case-control study. Neurology. 31: , ) Breuer, A. C., Furlan, A. J., Hanson, M. R. et al.: Central nervous system complications of coronary artery bypass grafting surgery: prospective analysis of 421 patients. Stroke 14: , ) Kuroda, Y., Uchimoto, R., Kaida, R. et al.: Central nervous systemic complications after cardiac surgery: a comparison between coronary artery bypass grafting and valve surgery. Anesth. Analg. 76: , ) Singh, A. K., Bert, A. A., Feng, W. C. et al.: Stroke during bypass grafting using hypothermic versus normothermic perfusion. Ann. Thor- and location of atherosclerotic plaques in the ascending aorta. J. Thorac. Cardiovasc. Surg. 96: , ) Marshall, W. G., Barzilai, B., Kouchoukous, N. T. et al.: lntraoperative ultrasonic imaging of ascending aorta. Ann. Thorac. Surg. 48: , ) Baker, A. J., Naser, B., Benaroia, M. et al.: Cerebral microemboli during coronary artery bypass using different cardioplegia techniques. Ann. Thorac. Surg. 59: , ) Isomura, T., Hisatomi, K., Satoh, T. et al.: Axillary artery cannulation for cardiopulmonary bypass in the presence of diseased ascending aorta. Eur. J. Cardio-Thorac. Surg. 10: 481, ) Mills, N. L. and Everson, C. T.: Atherosclerosis of the ascending aorta and coronary artery bypass. J. Thorac. Cardiovasc. Surg. 102: , ) Isomura, T., Hisatomi, K., Hirano, A. et al.: Use of the pedicled right gastroepiploic artery bypass grafting in the presence of calcified ascending aorta. J. Thorac. Cardiovasc. Surg. 108: , 1994.

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.k....-._.C.W.F.X.g01-01 20042005 Guidelines for the Clinical Application of Bypass Grafts and the Surgical Techniques (JCS 2006) 2006 11 1 2 2.1 2.1.1 CCAB 2.1.2 2.1.3 2.1.4 2.1.5 2.1.6 2.1.7 2.2 2.2.1 MIDCAB 2.2.2 2.3 CCAB OPCAB