Heart transplantation after emergency coronary artery bypass for failed angioplasty
F L Caes1, K J François, G Primo
1The Department of Cardiac Surgery, University Hospital, Ghent, Belgium.
Insights
A woman with coronary artery disease experienced complications after angioplasty, requiring bypass surgery and a ventricular assist device. Ultimately, she successfully underwent heart transplantation.
Area of Science:
- Cardiology
- Cardiac Surgery
- Transplantation Medicine
Background:
- Percutaneous transluminal coronary angioplasty (PTCA) can be complicated by arterial dissection and hemodynamic instability.
- Coronary artery bypass grafting (CABG) is a surgical option for complex coronary artery disease.
- Cardiogenic shock and myocardial infarction necessitate advanced circulatory support and potentially heart transplantation.
Purpose of the Study:
- To report a complex case of emergency cardiac surgery following failed coronary intervention.
- To illustrate the management of refractory cardiogenic shock and multi-organ dysfunction.
- To highlight the role of orthotopic heart transplantation in end-stage heart failure after failed revascularization attempts.
Main Methods:
- Case report of a 48-year-old female patient.
- Description of emergency coronary artery bypass grafting (CABG) for extensive dissection and cardiogenic shock post-PTCA.
- Utilization of left ventricular assist device (LVAD) for mechanical circulatory support.
- Performance of orthotopic heart transplantation due to massive myocardial infarction and inability to wean from cardiopulmonary bypass.
Main Results:
- The patient developed cardiogenic shock and ventricular fibrillation after failed PTCA of the left anterior descending coronary artery.
- Despite maximal medical support and LVAD, significant myocardial infarction occurred, leading to multi-organ dysfunction.
- Successful orthotopic heart transplantation was performed after 2 days of circulatory support.
Conclusions:
- Complex coronary artery dissection following PTCA can lead to severe hemodynamic compromise requiring emergent CABG.
- Mechanical circulatory support with LVAD may be a bridge to transplantation in patients with massive myocardial infarction.
- Orthotopic heart transplantation offers a viable solution for end-stage heart failure refractory to conventional surgical and medical management.
Abstract:
We describe the case of a 48-year-old woman who required emergency coronary artery bypass grafting because of extensive dissection, cardiogenic shock, and ventricular fibrillation after failed percutaneous transluminal coronary angioplasty for stenosis of a proximal left anterior descending coronary artery. Despite maximal inotropic support and intra-aortic balloon pumping, the patient could not be weaned from cardiopulmonary bypass, and a left ventricular assist device was placed. After 2 days of postoperative circulatory support, during which her respiratory and renal functions declined and cardiac output remained negligible due to a massive myocardial infarction, she underwent successful orthotopic heart transplantation.
