Off-pump coronary artery bypass in patients with Takayasu's disease

Area of Science:

• Cardiovascular Surgery
• Immunology
• Vascular Medicine

Background:

• Takayasu's arteritis is a large vessel vasculitis often affecting the aorta and its branches, potentially causing coronary artery stenosis.
• Coronary ostial stenosis in Takayasu's disease presents a surgical challenge for revascularization due to aortic involvement.
• Severe angina necessitates effective surgical intervention for patients with complex coronary and aortic disease.

Observation:

• Two patients with Takayasu's disease presented with ostial coronary artery stenosis and significant aortic calcification.
• Severe angina symptoms were present in both patients, indicating a need for urgent surgical management.
• Off-pump coronary artery bypass grafting (OPCABG) was performed in both cases.

Findings:

• Successful relief of severe angina was achieved using OPCABG in both patients.
• Innovative proximal anastomoses were utilized, including visceral arteries (right gastroepiploic, superior mesenteric, splenic) and an aortic connector system.
• The surgical strategy demonstrated the feasibility and effectiveness of OPCABG in this challenging patient cohort.

Implications:

• Off-pump coronary artery bypass grafting should be strongly considered for surgical coronary revascularization in patients with Takayasu's disease.
• These techniques expand the potential indications for OPCABG, offering a viable solution for complex cardiovascular cases.
• This approach may improve outcomes and quality of life for patients suffering from Takayasu's disease-related coronary complications.