*2.2.2 Placement*

• First, a purse suture with 2–0 polypropylene suture and rubber sleeve is used at the insertion point, and then mean arterial pressure is maintained at 100 mmHg (1 mmHg = 0.133 kPa) by medical management. The aorta wall is

**259**

*Management of Ascending Aorta Calcification in Coronary Artery Bypass Grafting*

then the sleeve is tightened to limit the bleeding.

tion perpendicular to the metal rod of the lower jaw.

aortic wall and then exhaust and knot (**Figure 2**).

**2.3 Key points of Enclose using technique**

punctured at the central position of the purse suture with the puncture needle

• The lower jaw of Enclose is inserted into the aorta through the above-mentioned puncture point and placed at the pre-selected anastomotic position, and

• Unscrew the membrane at the end of the lower jaw with the self-contained

• Adjust the knob of the upper jaw to move the upper arm vertically downward and then attach the aortic adventitia and tighten the fixator. When no blood flows out of the suction tube of the lower arm, a blood-free environment is formed between the intima and the arterial wall. Behind the suction tube, a 50 ml syringe can be connected to absorb a small amount of blood oozing from

• Use a circular knife to cut the aortic wall at the preselected anastomosis posi-

• Use Enclose' s own perforator to drill through the aortic incision. The perforator shall be close to the metal rod of the lower jaw to ensure full layer

Anastomosis of saphenous vein (A) to ascending aorta (B) is performed with 6–0 polypropylene suture. The local bleeding that affects the suture field can be removed by suction. At the same time, maintain systolic blood pressure of systemic circulation at 90–100 mmHg level to reduce bleeding and ensure full layer suture of

Close membrane after anastomosis and then release and remove Enclose. Knot the purse suture and use 2–0 polypropylene suture with felt pad to mattress suture

A considerable proportion of patients with coronary disease has ascending atherosclerosis. Many soft atherosclerotic plaques similar to "toothpastes" exist in the middle layer of ascending aorta, whereas obvious calcification can be identified by finger touch on the surface of aorta. Therefore, the plaques are prone to break and fall off after the application of side wall clamp and lead to organ embolism along with blood flow. In addition, except for the requirement of healthy aortic tissue at the puncture insertion point and anastomotic site, healthy tissue should also be selected between the two points as much as possible to avoid excessive bleeding due to atherosclerosis or calcification of the arterial wall between the two points, or plaque falling off due to extrusion.

*DOI: http://dx.doi.org/10.5772/intechopen.91909*

provided by Enclose.

rotary rod of Enclose.

the anastomosis area.

drilling (**Figure 1**).

*2.2.3 Anastomosis*

*2.2.4 Remove*

for reinforcement.

*2.3.1 Position selection*

punctured at the central position of the purse suture with the puncture needle provided by Enclose.

