THE CHALLENGE OF CALCIFIC AORTITIS

Coronary bypass and valvular operations have become more prevalent as the nation's elderly population grew 21% within the last decade. Ascending aortic calcification was a manifestation of this aging process. Aortic cannulation appeared impossible. Postoperatively, the stroke rate reached 14%, and the number of unexpected deaths rose sharply. Embolization of calcific and arteriosclerotic debris to cerebral and coronary vessels is believed to be the cause. The sharp, beveled, and narrowed jet-forming tips assaulted the delicate and soft intima of the artery. Nineteen cases of severely calcified aorta with increased predictable risk factors were operated on within the past 5 years. There were 12 coronary bypass grafts, 4 ventricular aneurysmectomies, and 3 valve replacements. Five of these cases were redo operations. The average age for these patients was 73.7 years. With the availability of the cannula introducer, we were able to find a small soft spot inside the arch or ascending aorta and cannulate these patients. We began to cool the patients down immediately and chose one of the three available methods for cardiac arrest. By changing the angle of application and direction of the axis of the clamp, we could cross-clamp the aorta loosely in 11 patients and administer cardioplegia. Intraluminal balloon occlusion of the ascending aorta was used once. The remainder of the cases had fibrillatory arrest. All proximal anastomoses in the coronary patients were done while on cross-clamp, intraluminal balloon occlusion, or brief periods of circulatory arrest. All sutures were passed from inside the aorta to avoid displacing or dissecting calcified plaques. There was no operative mortality, neurological deficit, or bleeding bring-backs in this group of patients.