Aortic plaque distribution in relation to cross clamp and cannulation procedures during cardiac surgery

Authors: Boivie, Patrik¹; Hansson, Magnus²; Engström, Karl Gunnar¹

Source: Scandinavian Cardiovascular Journal, Volume 41, Number 2, 2007 , pp. 120-125(6)

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Abstract:

Objective. Aortic atherosclerosis may cause cerebrovascular accidents in cardiac surgery. Aortic plaque distribution was analyzed in relation to surgical manipulation. Design. In 24 autopsy subjects the thoracic aorta was digitally analyzed by macro-anatomic mapping of plaques. Plaque density was compared in different anatomical segments. Hazards associated with surgical manipulation were blindly studied by superimposing cannulation and cross-clamp locations onto the maps. Results. Plaques were frequent. The anterior wall of the ascending/arch aorta had higher plaque density than its posterior side (p = 0.039). However, an anterior plaque predicted to 83% a concomitant plaque in the posterior wall. Plaque formation correlated with age (p = 0.004). The theoretical risk of interfering with a plaque during cannulation and/or clamp positioning was 46%. Conclusions. Plaque formation is a frequent and age-dependent problem. In the surgery-exposed aorta, the anterior wall had higher plaque density than the posterior side, although the two sides showed strong plaque coexistence. Furthermore, there was an unexpectedly high risk of plaque interference during cannulation and/or clamp maneuvers if blindly performed. The present results emphasize the importance of epiaortic scanning.

Keywords: Aortic atherosclerosis; cardiac surgery; cerebral protection; CVA; ultrasound

Document Type: Research article

DOI: http://dx.doi.org/10.1080/14017430601120398

Affiliations: 1: Department of Surgical and Perioperative Sciences, Umeå University Hospital, Umeå, Sweden 2: Department of Medical Biosciences, Section for Pathology, Umeå University Hospital, Umeå, Sweden

Publication date: 2007-01-01

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Aortic plaque distribution in relation to cross clamp and cannulation procedures during cardiac surgery

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