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Emergency off-pump coronary artery bypass grafting for acute left main coronary artery dissection
1Department of Anesthesiology, University Hospitals of Cleveland, Case Westem Reserve University School of Medicine, Ohio 44706-5007, USA.
Insights
Emergency off-pump coronary revascularization successfully treated acute left main coronary artery dissection in a patient with comorbidities. This approach avoided the extracorporeal circuit, offering a viable salvage strategy in complex cardiac cases.
Area of Science:
- Cardiology
- Cardiac Surgery
- Interventional Cardiology
Background:
- Acute left main coronary artery dissection is a rare but life-threatening complication during percutaneous coronary interventions.
- Managing such dissections requires prompt and effective revascularization strategies.
Observation:
- A 55-year-old woman with multiple comorbidities experienced acute left main coronary artery dissection during attempted percutaneous transluminal coronary angioplasty.
- The dissection necessitated an immediate surgical intervention.
Findings:
- Emergency off-pump coronary artery bypass grafting (CABG) was performed using the left internal thoracic artery and a saphenous vein graft.
- The revascularization successfully addressed the left anterior descending coronary artery and ramus intermedius.
- The procedure was technically successful, achieving myocardial revascularization without cardiopulmonary bypass.
Implications:
- Off-pump CABG can be a safe and effective salvage strategy in cases of iatrogenic coronary artery dissection.
- Avoiding the extracorporeal circuit may mitigate risks in high-risk patients, particularly when anesthesia concerns are present.
- This case highlights the importance of a multidisciplinary approach and adaptability in managing complex cardiac emergencies.
Abstract:
We report the case of a 55-year-old woman with multiple comorbid conditions in whom acute left main coronary artery dissection occurred during attempted percutaneous transluminal coronary angioplasty. After the dissection, the patient underwent emergency off-pump coronary revascularization of the left anterior descending coronary artery and ramus intermedius with use of the left internal thoracic artery and a saphenous vein graft, respectively The procedure was successful. The risks and benefits of avoiding the extracorporeal circuit in this case of catheterization laboratory salvage are discussed herein, along with some of the concerns about anesthesia that contributed to our decision to perform the operation off-pump.