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Coronary artery bypass grafting in a case with severe aortic atheromatosis associated with abdominal aortic aneurysm
Insights
This study presents a novel one-stage surgical approach for patients with coronary artery disease and abdominal aortic aneurysm. A modified low-flow cardiopulmonary bypass technique enabled successful coronary artery bypass grafting on a beating heart.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Cardiac Anesthesia
Background:
- Patients with concomitant coronary artery disease (CAD) and abdominal aortic aneurysm (AAA) present complex surgical challenges.
- Traditional cardiopulmonary bypass (CPB) can be high-risk in the presence of severe aortic atheromatous disease.
- Off-pump coronary artery bypass grafting (OPCAB) may be hazardous in patients with enlarged hearts and compromised ventricular function.
Observation:
- Severe atheromatous findings in the entire aorta precluded standard CPB during a one-stage operation for AAA and CAD.
- The patient had an enlarged heart with deteriorating function, making OPCAB a risky alternative.
Findings:
- A modified one-stage surgical strategy was successfully employed.
- Abdominal aortic aneurysm was repaired first using a bifurcated graft.
- Coronary artery bypass grafting (CABG) was subsequently performed on the beating heart using two arterial grafts, supported by a low-flow CPB connected to the bifurcated graft.
Implications:
- This modified low-flow CPB technique offers a viable solution for complex CABG in patients with severe aortic disease.
- The one-stage approach may improve outcomes for patients requiring simultaneous AAA repair and CABG.
- This strategy highlights the adaptability of CPB in challenging cardiovascular surgical scenarios.
Abstract:
A 69-year-old man with coronary artery disease associated with abdominal aortic aneurysm underwent a one-stage operation utilizing a low-flow cardiopulmonary bypass. Ordinary cardiopulmonary bypass was abandoned as a result of severe atheromatous finding in the entire aorta. However, coronary artery bypass grafting without cardiopulmonary bypass was hazardous as a result of heart enlargement and deteriorating function. Therefore, the abdominal aortic aneurysm was first replaced with a bifurcated graft. Coronary artery bypass grafting with two arterial grafts was then performed successfully on the beating heart with the support of a low-flow cardiopulmonary bypass connected to the bifurcated graft.