Comprehensive approach for clamping severely calcified ascending aorta using computed tomography

A severely calcified ascending aorta is generally considered unclampable. Many surgeons have developed procedures to avoid manipulation such as cross-clamping on such calcified aorta. However, these alternatives are sometimes complicated and require a more invasive procedure than the conventional method. We assessed our comprehensive strategy for clamping of a severely calcified aorta using preoperative computed tomography (CT). We found that the extent of calcification just below the innominate artery was significantly less than that at the usual ascending aorta clamp site. After confirming that the extent of calcification just below the innominate artery was <75% of the entire circumference by preoperative CT, ascending aorta was clamped with a soft cross-clamp placed on the ascending aorta with particular care to orientate the clamp parallel to the calcification. All operations were completed under usual cardiopulmonary bypass with mild hypothermia. All patients survived surgery and no patients had a postoperative neurological complication. Our results provide important information for the management of these high-risk patients, with a comprehensive approach used to choose the appropriate option for an optimal outcome.