[Successful off-pump coronary artery bypass for a patient with aplastic anemia]
1Department of Cardiovascular Surgery, Osaka City University Medical School, Osaka, Japan.
Insights
A 61-year-old man with severe aplastic anemia and coronary artery disease underwent successful off-pump coronary artery bypass (OPCAB). Careful perioperative management, including platelet transfusions and granulocyte colony-stimulating factor (G-CSF), ensured a positive outcome.
Area of Science:
- Cardiology
- Hematology
- Surgical Innovation
Background:
- Aplastic anemia presents significant challenges for cardiac surgery due to pancytopenia.
- Severe left main coronary artery stenosis necessitates urgent revascularization.
Observation:
- A 61-year-old male patient with aplastic anemia (WBC 2,200/microl, Hb 8.1g/dl, PLT 16,000/microl) experienced angina pectoris.
- Coronary angiography revealed severe left main coronary artery stenosis.
Findings:
- The patient successfully underwent off-pump coronary artery bypass (OPCAB) surgery using left internal thoracic and radial artery grafts.
- Intraoperative management included 30 units of platelet transfusions, resulting in minimal hemorrhage.
- Postoperative administration of granulocyte colony-stimulating factor (G-CSF) prevented major infections.
Implications:
- Off-pump coronary artery bypass (OPCAB) is a viable and effective revascularization strategy for patients with severe aplastic anemia.
- Meticulous perioperative management, including blood product support and G-CSF, is crucial for optimizing outcomes in these high-risk patients.
- This case highlights the successful multidisciplinary approach in managing complex cardiac and hematological conditions.
Abstract:
We report a 61-year-old man with aplastic anemia who underwent successful off-pump coronary artery bypass (OPCAB) after being admitted for angina pectoris. Coronary angiography showed severe stenosis of the left main coronary artery. Preoperative WBC was 2,200/microl, neutrophil 704/microl, Hb 8.1g/dl, and PLT 16,000/microl. We conducted OPCAB on double vessels using left internal thoracic and radial artery grafts. Thirty units of platelets were transfused intraoperatively with little perioperaive hemorrhage. Because of high grade fever, we injected 150 microg granulocyte colony-stimulating factor (G-CSF) every 3 days postoperatively to prevent major infection. The combination of appropriate perioperative management and OPCAB yielded an effective result for a patient with severe hematological disorders causing pancytopenia.
More Related Videos
09:12Surgical Swine Model of Chronic Cardiac Ischemia Treated by Off-Pump Coronary Artery Bypass Graft Surgery
Published on: March 27, 2018
05:25Surgical Porcine Model of Chronic Myocardial Ischemia Treated by Exosome-laden Collagen Patch and Off-pump Coronary Artery Bypass Graft
Published on: September 15, 2023
