Combined Aortic Valve Replacement and Coronary Artery Bypass Grafting with in situ Arterial Grafts for Porcelain Aorta

Kentaro Tamura, MD, Fumikazu Nomura, MD, Shogo Mukai, MD, Masao Yoshitatsu, MD, Jun Sakao, MD, and Katsuhiko Ihara, MD

Patients with porcelain aorta carry a high risk of cerebral as well as systemic embolism during cardiac surgery. Here we describe a case of severe aortic stenosis and coronary artery disease combined with the circumferentially calcified aorta. The patient was a 77-year-old man who successfully received four coronary artery bypass grafts with in situ arterial grafts without clamping the aorta and aortic valve replacement. Aortic valve replacement and two distal coronary artery anastomoses to the left circumflex artery and obtuse marginal branch were performed under cardiac arrest during hypothermic perfusion with endoaortic balloon occlusion, followed by partial endarterectomy and closure of the aorta buttressed with bovine pericardium under deep hypothermic circulatory arrest. While rewarming, the other two distal coronary anastomoses to the left anterior descending artery and diagonal branch were done on the beating heart in order to minimize cardiac arrest time. On-pump beating heart coronary artery bypass grafting (CABG) can be useful especially for combined complex cardiac surgery. (Ann Thorac Cardiovasc Surg 2003; 9: 206-208)

Key words: porcelain aorta, balloon occlusion, aortic stenosis, hypothermic circulatory arrest

From Department of Cardiovascular Surgery, National Hospital Kure Medical Center, Hiroshima, Japan

Received November 25, 2002; accepted for publication January 28, 2003
Address reprint requests to Kentaro Tamura, MD: Department of Cardiovascular Surgery, National Hospital Kure Medical Center, 3-1 Aoyama, Kure, Hiroshima 737-0023, Japan.