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Published on: March 27, 2018
Beating heart coronary artery bypass surgery after orthotopic heart transplantation
1Division of Cardiothoracic Surgery, Ohio State University College of Medicine, Columbus, Ohio, USA.
Insights
This study reports successful off-pump coronary artery bypass surgery for accelerated transplant coronary artery disease in a heart transplant recipient. The beating-heart procedure provided symptom relief and improved graft patency, offering a viable treatment option.
Area of Science:
- Cardiology
- Cardiac Surgery
- Transplantation
Background:
- Accelerated transplant coronary artery disease (TAD) is a significant long-term complication following orthotopic heart transplantation.
- TAD can progress rapidly, leading to graft dysfunction and patient morbidity.
Observation:
- A 52-year-old male heart transplant recipient developed rapidly progressing triple-vessel disease 10 years post-transplant.
- Symptoms included worsening shortness of breath and chest pain due to TAD.
Findings:
- The patient underwent successful off-pump coronary artery bypass surgery using the left internal mammary artery to the left anterior descending artery.
- The circumflex artery was not amenable to grafting due to diffuse small vessel disease.
- Postoperative angiography confirmed widely patent bypass graft, and the patient remained symptom-free at 1-year follow-up.
Implications:
- Off-pump coronary artery bypass surgery can be an effective revascularization strategy for select heart transplant recipients with advanced TAD.
- This approach offers a potential solution for managing complex coronary artery disease in the context of prior transplantation.
- Maintaining graft patency and symptom relief is crucial for long-term outcomes in heart transplant patients with coronary complications.
Abstract:
Beating-heart coronary artery bypass surgery was performed in a 52-year-old man with accelerated transplant coronary artery disease 10 years after orthotopic heart transplantation. Transplant coronary artery disease was first detected in the left circumflex coronary artery 9 years after transplantation. Rapid progression to triple vessel disease occurred within 1 year, and the patient developed worsening symptoms of shortness of breath and chest pain. He underwent off-pump "beating heart" left internal mammary artery to left anterior descending coronary artery bypass surgery. The circumflex coronary artery was not graftable due to diffuse and truncated small vessel disease. His postoperative course was uneventful and he was discharged on the fifth postoperative day. Coronary angiography 3 months after the surgery revealed a widely patent left internal mammary artery to left anterior descending artery bypass. He is alive and symptom free more than 1 year after his surgery.
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