AN UNUSUAL ORIGIN OF PROXIMAL CORONARY BYPASS ANASTOMOSIS IN A PATIENT WITH CAROTID DISEASE NEUOBIČAJENO ISHODIŠTE PROKSIMALNE ANASTOMOZE AORTOKORONARNOG BAJ- PASA KOD SIMULTANE KAROTIDNE I KORONARNE REVASKULARIZACIJE

Neurological complications constitute a major cause of morbidity and mortality following coro- nary artery bypass grafting. Extensive atherosclerosis of the aortic arch and carotid artery disease are asso - ciated with high incidence of stroke. Severe calcification of the ascending aorta (porcelain aorta) is a very difficult condition in cardiac surgery because of high embolization potential during the process of cannula - tion, aortic cross-clamping, and is particularly difficult for suturing of proximal anastomosis. We describe a case of a 75-year-old male referred to our Clinic due to unstable angina. Further evaluation revealed a se- vere, high-grade multilevel fibrolipid symptomatic carotid stenosis, severe aortic valve stenosis and left an - terior descending coronary artery stenosis and a highly calcified ascending aorta and aortic arch. We per - formed simultaneous carotid endarterectomy, revascularization of the left anterior descending coronary ar - tery and aortic valve replacement. Proximal venous anastomosis was created in the left common carotid artery. The case suggests an alternative method for treating patients with severe aortic calcifications.