Off-pump coronary artery bypass surgery in a renal transplant patient

Area of Science:

• Cardiovascular Surgery
• Nephrology
• Transplantation Medicine

Background:

• Off-pump coronary artery bypass grafting (OPCAB) is infrequently performed in renal transplant recipients.
• Coronary artery disease poses a significant risk in patients with end-stage renal disease and post-transplant complications.

Observation:

• A 59-year-old male renal transplant recipient presented with unstable angina pectoris.
• Coronary angiography identified severe triple-vessel disease, necessitating urgent intervention.
• The patient underwent emergency off-pump coronary artery bypass grafting with intraaortic balloon pumping support.

Findings:

• Complete revascularization was achieved successfully using OPCAB.
• The patient's hemodynamic status remained stable postoperatively, allowing for early cessation of intraaortic balloon pumping.
• Immunosuppressive therapy was managed without compromising cardiac surgical recovery or renal function.

Implications:

• This case demonstrates the feasibility and safety of emergency OPCAB in selected renal transplant recipients with severe coronary artery disease.
• Successful surgical management can improve angina symptoms and long-term prognosis in this high-risk patient population.
• Careful perioperative management, including immunosuppression, is crucial for optimal outcomes in combined cardiac and transplant surgery.