Surgical strategies for severely atherosclerotic (porcelain) aorta during coronary artery bypass grafting

Core Tip

Core Tip: Porcelain aorta (PA) is a serious atherosclerotic disease that prevents manipulation of the aorta, and it is seen in 2% to 9.3% of the patients undergoing elective coronary artery bypass grafting (CABG). Although various mechanisms have been proposed to explain the development of stroke in cardiac surgery, embolic events resulting from manipulation of the ascending aorta are the main cause of stroke. Perioperative stroke is still among the most crucial complications of CABG surgery with its high patient morbidity and mortality. The best approach to prevent embolic events is the use of alternative surgical techniques which aim to minimize or eliminate the manipulation of a severely atherosclerotic or completely calcified aorta. Here, surgical strategies which are used for the management of patients with PA are summarized.