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Direct Re-implantation of Left Coronary Artery into the Aorta in Adults with Anomalous Origin of Left Coronary Artery from the Pulmonary Artery (ALCAPA)
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Coronary artery bypass grafting in a case with severe aortic atheromatosis associated with abdominal aortic aneurysm

H Ogino1, Y Ueda, T Sugita

  • 1Department of Cardiovascular Surgery, Tenri Hospital, Nara, Japan.

The Japanese Journal of Thoracic and Cardiovascular Surgery : Official Publication of the Japanese Association for Thoracic Surgery = Nihon Kyobu Geka Gakkai Zasshi
|July 14, 1999
PubMed

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.

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