Aortic plaque distribution in relation to cross clamp and cannulation procedures during cardiac surgery

Figures & data

Table I.  Subject demographics, autopsy data, aortic characteristics and cause of death.

	n (%)	Mean±SEM	Range
Age (years)		70.9±2.6	48–97
Males	19 (79)
Clinical diagnosis
Previous CVA	7 (29)
Diabetes mellitus	4 (17)
Hypertension	5 (21)
Cardiac data at autopsy
Cardiac weight (g)		448.5±25.4	254–823
Coronary disease	17 (71)
Valvular disease	11 (46)
Previous myocardial infarction	8 (33)
Left ventricular hypertrophy	6 (25)
Aortic observations at autopsy
Aortic diameter (mm)		32.2±0.7	25–38
Aortic wall thickness (mm)		1.6±0.1	1.1–2.3
Presence of ulcerative plaque	14 (58)
Cause of death
Acute myocardial infarction	9 (37)
Circulatory failure, unspecified	5 (21)
Non-cardiac death	10 (42)

Table II.  Plaque characteristics of thoracic aorta with subdivision into anatomic regions.

					Ascendens			Descendens
	Entire thoracic aorta	Entire Ascendens	Entire Descendens	p value^a	Ant wall	Post wall	p value^b	Ant wall	Post wall	p value^b
Plaque density (%)	15.9±3.6	13.1±3.3	18.8±4.9	0.317	15.1±3.4	12.1±3.6	0.039	17.8±4.0	20.4±5.1	0.426
Plaque number (n)	7.0±1.0	3.3±0.4	4.6±0.7		2.2±0.3	2.0±0.3		3.0±0.5	3.0±0.5
Plaque geometry
Long axis (mm)	27.3±4.1	25.2±3.9	26.1±4.0		22.0±3.1	20.6±3.5		23.1±3.9	25.6± 5.3
Circular diameter (mm)	18.2±2.4	16.8±2.6	17.1±2.7		15.0±2.0	13.4±2.4		14.6±2.3	15.9±2.9
Shape factor	0.71±0.02	0.68±0.02	0.68±0.03		0.68±0.03	0.66±0.03		0.67±0.02	0.65±0.04

Ascendens includs aortic arch.

Note that for segmental and wall subdivision overlapping plaques were digitally cut, which affects recorded plaque numbers and geometry.

^aAscending versus descending aorta. ^bAnterior versus posterior wall. Mean±sem.

The terms ‘Ant’ and ‘Post’ refer to the anterior and posterior walls of the aorta, respectively.

Figure 1.  Plaque density in relation to age, expressed for the entire thoracic aorta.

Figure 2.  Frequency distribution of plaque size (recalculated into circular diameter), expressed for the entire thoracic aorta. Data from all subjects were pooled and subdivided according to diameter intervals (n = 24 subjects, n = 169 recorded plaques).

Figure 3.  Correlation of plaque density between anterior and posterior walls of the ascending/arch aorta.

Table III.  Magnitude of plaque density in relation to subject characteristics.

	Entire thoracic aorta		Ascendens		Descendens
	%	p value	%	p value	%	p value
Change in plaque density by:
Age (per decade of age increase)	8.0	0.004	5.5	0.006	10.2	0.001
Female versus male gender	91	0.500	72	0.145	106	0.414
Presence of coronary disease	221	0.061	165	0.465	571	0.008
Presence of valvular disease	175	0.034	91	0.469	235	0.093
Cardiac weight (per 100 g increase)	−1.8	0.616	−1.6	0.809	−1.72	0.759
Aortic diameter (per 5 mm increase)^a	8.8	0.009	5.1	0.079	12.3	<0.001
Aortic wall thickness (per 1 mm increase)	−3.4	0.579	−1.4	0.822	−5.1	0.528

Ascendens includs aortic arch.

Data refer to the correlation between relative plaque density and the presence of, or incremental increase in, listed parameters.

^aAortic diameter was measured in the ascending part.

Table IV.  Risk of plaque interference by clamp and/or cannula.

		Clamp hit	No clamp hit
Cannula hit	n (%)	3 (12.5)	4 (16.7)
No cannula hit	n (%)	4 (16.7)	13 (54.2)

n = 24.