Introduction: An aging society brings with it a wide range of
medical problems, one of which is an increasing number of patients with
a severely calcified aorta1. These patients, who often
require thoracic aortic surgery, may encounter numerous obstacles during
the surgery. For one, the calcified intima interferes with suturing of
the aorta, thereby renders aortic anastomosis to be difficult. Moreover,
should the calcified aorta be forcibly sutured, the aortic wall may
split and lead to bleeding or rupture. In view of the increased risk of
complications that would affect the surgical plan and outcome, it is
important to predict the extent of aortic calcification preoperatively.
Computed tomography (CT) is a useful device for diagnosis of calcified
lesions, but no quantitative evaluation has been established to predict
whether simple anastomosis or any additional manipulation such as
endarterectomy is required during operation. Here, we conducted this
retrospective study to establish the reference value range of the
maximal CT value for application of simple anastomosis in thoracic
aortic surgery.
Patients and Methods: Between 2007 and 2011, 122 consecutive
patients (mean age = 67 ± 14 years) underwent replacement of the
thoracic aorta were included in this study. Patients with acute aortic
dissection were excluded, though those with chronic aortic dissection
were included such as dissecting aortic aneurysm. We divided the 122
patients into 2 groups, 105 patients (mean age = 66 ± 14) underwent
simple anastomosis (Simple group), and 17 patients (mean age = 73 ± 6)
required endarterectomy before undergoing anastomosis (Manipulation
group). Preoperative CT scans were taken and the maximal CT value at the
anastomosis site in comparison with postoperative CT was calculated
using a diagnostic imaging software (AZE Virtual Place Raijin, Aze Ltd.,
Tokyo, Japan), based on the peak Hounsfield unit (HU) of the detected
calcified lesions. When it was less than 130 HU, we defined 0 HU at the
area. The institutional review board approved this retrospective study.
Informed consent was obtained from all patients.