Wash out technique for proximal anastomosis in atherosclerotic ascending aorta.

BACKGROUND: Especially among elderly patients embolisms originating from atheromatous plaques in the ascending aorta are responsible for cardiac and cerebral events during coronary bypass surgery. Unfortunately smooth atheromatous degeneration of the aorta often can not be detected even by transoesophageal echocardiography. METHODS: In four patients with unexpected atheromatous material of the punched ascending aorta the so called "wash out technique" was performed. A side-to-end anastomosis between a segment of vein and the partially clamped ascending aorta was performed. For several minutes the ascending aorta was left to bleed through the venous stump. Without further manipulation of the ascending aorta the coronary bypass graft was completed by an end-to-end anastomosis between the venous stump and the venous graft. Oral anticoagulation in combination with a low dose platelet antiaggregation drug was given for at least one year. RESULTS: All patients had an uncomplicated postoperative course, especially with regard to neurological damage or ECG changes. CONCLUSIONS: In patients with unexpected atheromatous pathology of the ascending aorta the "wash out technique" of coronary artery bypass grafting minimises direct embolisation into the cardiac area perfused by the new bypass grafts.