The whole nine yards: multiple cardiac surgical and percutaneous interventions in a patient during 30 years of care

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Medical Technology

Background:

• Coronary artery disease (CAD) management has evolved significantly over the past three decades.
• Long-term patient outcomes require comprehensive and adaptable treatment strategies.

Observation:

• A 38-year-old male with angina pectoris post-myocardial infarction experienced 28 years of complex CAD requiring extensive interventions.
• The patient underwent multiple coronary artery bypass graft surgeries, percutaneous coronary interventions, and diagnostic angiograms.

Findings:

• Treatment modalities included various grafting techniques (saphenous vein, internal mammary, gastroepiploic arteries), percutaneous transluminal coronary angioplasty, atherectomy, and stenting (bare-metal and drug-eluting).
• Advanced therapies for complications included treatment for in-stent restenosis, left main and circumflex artery stenting, and intracoronary pressure wire diagnostics.
• Pharmacological management (statins, antiplatelets, ACE inhibitors) was complemented by device implantation (biventricular automatic implantable cardioverter-defibrillator) and radiofrequency ablation for arrhythmias and heart failure.

Implications:

• This case exemplifies the 'whole nine yards' of available treatments for CAD, reflecting 30 years of technological advancement.
• Such extensive interventions underscore the potential for long-term management of complex coronary artery disease.
• The case highlights the multidisciplinary approach and technological progress in interventional cardiology for improving patient survival and quality of life.