Combined Coronary Artery Bypass Grafting, Abdominal Aortic Repair and Aortic Valve Replacement in a Case with Porcelain Aorta

(Department of Surgery II, Ehime University School of Medicine, Ehime, Japan)

Kanji Kawachi Tatsuhiro Nakata Yoshihiro Hamada
Shinji Takano Nobuo Tsunooka Yoshitsugu Nakamura
Atsushi Horiuchi Katsutoshi Miyauchi Yuuji Watanabe
A 73-year-old woman was admitted to undergo three simultaneous operations: aortic valve replacement (AVR), coronary artery bypass grafting (CABG) and abdominal aortic aneurysm repair. She had previously undergone percutaneous catheter intervention in the left coronary anterior descending artery. Computed tomography revealed an abdominal aortic aneurysm 5 cm in diameter. Aortic valve stenosis (AS) was shown with a pressure gradient of 60 mmHg, and 90% stenosis of the distal right coronary artery was also shown. CT scan and aortography revealed porcelain ascending aorta. The patient underwent simultaneous operations because of severe AS, coronary artery disease and abdominal aortic aneurysm. An aortic cannula was placed in a position higher in the ascending aorta with no calcification. Cardiopulmonary bypass was started using a two-staged venous cannula through the right atrium. At first, AVR was performed with cardioplegic solution and ice slush. Because it was difficult to inject the cardioplegic solution into the coronary artery selectively due to the calcified orifice of coronary artery, we closed it immediately by removing the calcified intima of the porcelain aorta after completion of AVR. The second cardioplegic solution was injected through the ascending aorta. Next, CABG to RCA was performed using the right gastroepiploic artery without anastomosis to the ascending aorta. Cardiac surgery was first performed, followed by abdominal aortic aneurysm repair after discontinuation of cardiopulmonary bypass. The patient was extubated the next day and stayed for two days in the intensive care unit. She is very well now one year after the operation.
@Jpn. J. Cardiovasc. Surg. 31F344-346 (2002)