Hybrid myocardial revascularization complicated by delayed anastomotic bleeding

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Anastomotic Complications

Background:

• Hybrid coronary revascularization combines surgical and percutaneous techniques for treating coronary artery disease.
• The left internal mammary artery (LIMA) is frequently used for revascularization of the left anterior descending (LAD) artery.
• Delayed bleeding is a potential, though uncommon, complication following coronary artery bypass grafting.

Observation:

• A case of hybrid coronary revascularization is presented, involving LIMA-to-LAD anastomosis via thoracotomy.
• The patient underwent successful percutaneous coronary intervention (PCI) for residual stenoses 13 days post-surgery.
• Cardiac tamponade occurred shortly after PCI, attributed to dehiscence at the LIMA-LAD anastomotic site.

Findings:

• The primary finding is a rare complication of delayed bleeding from a LIMA-LAD anastomosis after hybrid coronary revascularization.
• Anastomotic site dehiscence leading to cardiac tamponade was diagnosed following PCI.
• The case underscores the importance of monitoring for delayed complications even after successful initial procedures.

Implications:

• This case highlights the need for vigilance regarding anastomotic integrity in hybrid coronary revascularization.
• Understanding the mechanisms of delayed bleeding is crucial for preventing similar adverse events.
• Further research into optimizing anastomotic techniques and post-operative surveillance in hybrid procedures may be warranted.