Severe Calcification of the Ascending Aorta Detected Incidentally in Patients Undergoing Coronary Artery Bypass Grafting

Introduction: Incidentally discovered severe calcification of the ascending aorta is a major challenge facing surgeons during routine on-pump coronary artery bypass grafting (CABG) surgery with major surgical and clinical consequences. The aim of this study is to evaluate the outcome in patients undergoing CABG under this condition with initial replacement of the calcified ascending aorta (CAA).

Methods: A retrospective study on a cohort of 74 patients (28.4% female, mean age: 73 ± 7 years) underwent initial replacement of an incidentally discovered CAA using deep hypothermic circulatory arrest (DHCA) within CABG between 2007 and 2015. A control group was matched according to age, gender and procedure (only CABG or combined with valve replacement).

Results: No significant differences were noted between both groups with regard to preoperative risk factors. EuroScore was higher in the in the study group [9.1% (6.3 to 11.6) versus 6.9% (3.4 to 8.3)]. Intraoperatively, due to DHCA the extracorporeal circulation time (210 ± 64 minute vs. 152 ± 52 minute; p < 0.001) and cross-clamping time (135 ± 46 minute vs. 104 ± 44 minute; p < 0.001) were significantly longer in the study group. Postoperatively, no significant differences in complications and major morbidity were observed between the groups. There was no significant difference in regard to incidence of neurological adverse (5.4 vs. 2.7%; p = 0.68) or 30-days mortality rate (6.7 vs. 4.1%; p = 0.72).

Conclusion: Our study showed that initial replacement of incidentally CAA using DHCA in patients undergoing CABG was not associated with increased risks for neurologic adverse and mortality. Satisfactory outcomes should encourage the offering of replacement the CAA using DHCA in these patients.