Atherosclerotic ascending aorta: Management during coronary artery bypass graft surgery

Abstract Patients presenting for coronary artery bypass grafting are older with more extensive vascular disease than was the case in the previous decade. Severe atherosclerotic disease of the ascending aorta is encountered in these patients. We describe 4 patients who underwent successful coronary artery bypass grafting. Manipulation of the aorta was avoided by modification of the techniques of arterial cannulation (using the femoral artery) and myocardial protection (fibrillation with venting and core cooling). Novel techniques of coronary revascularisation were used; that is, proximal ends of vein grafts were anastomosed to the internal mammary artery.