Off-pump coronary artery bypass in a patient with the antiphospholipid syndrome

Area of Science:

• Cardiology
• Immunology
• Vascular Surgery

Background:

• Antiphospholipid syndrome (APS) is associated with increased thromboembolic complications, posing significant risks for patients undergoing cardiovascular surgery.
• Repetitive coronary occlusion after percutaneous transluminal coronary angioplasty (PTCA) is a known complication in APS patients.
• Primary APS diagnosis was confirmed by elevated lupus anticoagulant levels (217 s).

Observation:

• A patient with primary APS experienced recurrent coronary artery stenosis despite medical management including steroid pulsation, plasmapheresis, and cyclophosphamide.
• The patient had a history of drug allergy to ticlopidine hydrochloride and aspirin, limiting medical treatment options.
• Cardiopulmonary bypass was contraindicated due to the risk of exaggerated coagulatory and fibrinolytic complications in APS.

Findings:

• Off-pump coronary artery bypass grafting (OPCAB) was successfully performed using the left internal thoracic artery (ITA) to bypass the left anterior descending (LAD) lesion.
• The patient remained free of cardiovascular complaints for 3 years post-surgery.
• This case demonstrates the feasibility and success of OPCAB in a high-risk APS patient.

Implications:

• Off-pump CABG (OPCAB) is a viable and safe alternative surgical strategy for patients with antiphospholipid syndrome (APS) who are not candidates for conventional cardiopulmonary bypass.
• Successful OPCAB can lead to long-term positive outcomes in APS patients with complex coronary artery disease.
• Further research into surgical management of cardiovascular disease in APS patients is warranted.