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J Thorac Cardiovasc Surg 2003;125:1200-1201
© 2003 The American Association for Thoracic Surgery

Editorials

Aortic nightmares: Can we sleep better?

From the Wake Forest University Health Sciences, Winston-Salem, NC.

Received for publication Sept 10, 2002. Accepted for publication Sept 17, 2002. Address for reprints: John W. Hammon, Professor of Surgery, Wake Forest University Health Sciences, Medical Center Boulevard, Winston-Salem, NC 27157-1096. (E-mail: jhammon@wfubmc.edu).

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See related article on page 1451.

One of the recurring nightmares facing surgeons who operate on the thoracic aorta involves incising the aorta and visualizing severe degenerative atherosclerosis with toothpaste-like material in the wall of the aorta and the interior of the aorta lined with ulcerations containing platelet, fibrin strands, and, in some cases, actual blood clots. If a clamp is applied to this aorta, it is not difficult to imagine this material breaking away and embolizing to vital organs, causing severe complications. As the authors of "Embolic material generated by multiple aortic crossclamping: A perfusion model with human cadaveric aorta" point out, repeated clamping of atherosclerotic aortas releases not only calcified atherosclerotic debris, but smaller emboli consistent with cellular debris as well. On the basis of their data, it is hard to believe that any patient with aortic atherosclerosis, who undergoes surgery involving aortic clamping, does not end up with some permanent, severe organ damage related to intraoperative embolization.

Fortunately, a quick review of the cardiac surgery literature would suggest that the incidence of permanent stroke, renal failure, and other severe organ damage and death are quite low in clinical cardiac surgery today, ^1,2 although it has been . . . [Full Text of this Article]

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