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Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
Abstract: (3 Views)
Aortic calcification is an advanced atherosclerotic manifestation strongly linked to perioperative stroke and neurological sequelae following coronary artery bypass grafting (CABG). This case report delineates the successful utilization of systemic hyperkalemic cardiac arrest as an innovative, cross-clamp-free operative strategy during urgent CABG in a 72-year-old man presenting with critical triple-vessel disease and progressive hemodynamic instability that precluded safe off-pump revascularization. Preoperative computed tomography revealed dense calcified plaques along the ascending aorta, specifically encompassing the prospective cross-clamp site. By employing systemic hyperkalemic cardiac arrest under moderate systemic hypothermia (29°C) combined with adjunctive external cranial cooling and meticulous intraoperative glucose-insulin management during rewarming, complete myocardial revascularization was safely achieved without any direct mechanical manipulation or clamping of the diseased aortic wall. Total cardiopulmonary bypass and cardiac arrest times were 115 and 74 minutes, respectively. The patient experienced an uneventful postoperative recovery, maintaining stable hemodynamics, and was successfully discharged on postoperative day 7 free of any focal or global neurological deficits. This case highlights that vigilant preoperative aortic mapping and the complete avoidance of mechanical cross-clamping via controlled systemic hyperkalemic arrest represent an effective and cerebral-protective therapeutic alternative for high-risk patients with severely calcified or porcelain aortas.
Keywords: Aortic Calcification, Coronary Artery Bypass, Cardiopulmonary Bypass, Cardiac Arrest, Hyperkalemia
Type of Study: Case Report |
Subject:
Heart Surgery
Received: 2026/06/28 | Accepted: 2026/08/31 | ePublished ahead of print: 2026/11/9
Received: 2026/06/28 | Accepted: 2026/08/31 | ePublished ahead of print: 2026/11/9
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