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A case report of off-pump coronary artery bypass grafting associated with recent neurological deficit
Shigemitsu Suzuki1, Kenichi Kosuga, Ko Tanaka
1Division of Cardiovascular Surgery, Munakata General Hospital, 341-1 Kamisaigo, Fukuma-machi, Munakata-gun, Fukuoka 811-3207, Japan.
Insights
Off-pump coronary artery bypass grafting (OPCAB) is a viable option for high-risk patients with recent neurological deficits. This surgical approach proved successful in a patient experiencing cardiogenic shock after a stroke.
Area of Science:
- Cardiology
- Neurology
- Cardiovascular Surgery
Background:
- A 77-year-old male with a history of cerebral infarction presented with chest oppression.
- Coronary angiography identified two-vessel disease involving the left main trunk, necessitating coronary artery bypass grafting (CABG).
Observation:
- The patient developed hemiparesis, leading to a postponement of the scheduled CABG.
- Subsequently, he experienced severe chest pain and cardiogenic shock, indicating acute cardiac deterioration.
- Off-pump coronary artery bypass grafting (OPCAB) was performed on the fifth day post-neurological deficit onset.
Findings:
- The OPCAB procedure was successfully completed without complications.
- The patient's postoperative recovery was uneventful, demonstrating successful management of both cardiac and neurological conditions.
Implications:
- OPCAB can be a safe and effective alternative for high-risk patients with recent neurological deficits requiring coronary revascularization.
- This case highlights the importance of tailored surgical strategies in complex cardiovascular cases with coexisting neurological issues.
Abstract:
A 77-year-old man with a history of cerebral infarction was admitted to our hospital with chest oppression. Coronary angiography revealed 2-vessel disease involving left main trunk. Coronary artery bypass grafting to left anterior descending artery and obtuse marginal branch was scheduled, but the patient developed hemiparesis and the scheduled coronary artery bypass grafting was postponed by at least one month. Unfortunately, the patient complained of severe chest pain at midnight of the second day from the onset of the neurological deficits and went into cardiogenic shock. We performed off-pump coronary artery bypass grafting to left anterior descending artery on the 5th day from the onset of the neurological deficits. His postoperative course was uneventful. Off-pump coronary artery bypass grafting is appropriate as an alternative procedure for high-risk patients with recent neurological deficits.
