Open anastomosis: an alternative for proximal vein graft anastomoses in significantly diseased aortas

Abstract

We describe a simple technique of constructing proximal vein graft anastomoses, in an open fashion, under brief periods of very low pump flows. We have used this technique without complications in more than 100 patients with significantly diseased ascending aorta wall. In our opinion, this technique is a good alternative to other, more complex, approaches often described.

Aorta non-clamp technique in case of sclerotic ascending aorta during coronary artery bypass grafting

“…However, we believe the institution of a vent is important for better myocardial protection. I thank Ugurlucan et al [1] for their comment to my paper [2]. They inform of a similar technique previously published by their group.…”

“…The aorta non-clamp technique is a safer alternative in this particular group of patients. It may be performed on a fibrillating or decompressed beating heart [1]. However, we believe the institution of a vent is important for better myocardial protection.…”

“…We read with great interest the manuscript by Antunes MJ in which the author presented an open-anastomosis technique for proximal vein-graft anastomoses in case of sclerotic ascending aorta [1]. We present our comments on the paper from a few technical aspects.…”

“…Single or multiple clamping of the aorta during conventional cross-clamp cardioplegia and intermittent cross-clamp fibrillation techniques carries high risk of embolisation of the atheromatous material in the presence of a calcified ascending aorta [1][2][3]. The aorta non-clamp technique is a safer alternative in this particular group of patients.…”

“…Before anastomosing the internal thoracic artery to the left anterior descending artery, we perform the proximal anastomoses. Proximal anastomoses are performed to the clean segments of the ascending aorta [1][2][3] if available on low flow with mean arterial pressure of 20-25 mm Hg, otherwise to the innominate or the internal thoracic artery [2,3]. We place ice bags around the head of the patient and the table is tilted to place the patient in the Trendelenburg position during low flow.…”