Coronary artery bypass grafting in a patient with cryoglobulinemia

Area of Science:

• Cardiovascular Surgery
• Hematology
• Nephrology

Background:

• Cryoglobulinemia poses significant risks during cardiopulmonary bypass due to potential cryoprecipitation.
• Managing cryoglobulin levels is crucial for preventing complications in patients undergoing cardiac surgery.

Observation:

• A patient with cryoglobulinemia underwent coronary artery bypass grafting (CABG).
• Double filtration plasmapheresis (DFPP) was administered preoperatively, postoperatively, and during cardiopulmonary bypass to reduce cryoglobulin concentration.
• The surgery was performed using total cardiopulmonary bypass, moderate hypothermia, and ventricular fibrillation without aortic crossclamping.

Findings:

• The patient experienced no adverse effects related to cryoglobulin during the perioperative and postoperative periods.
• The described surgical technique facilitated a safe open-heart procedure in the presence of cryoglobulinemia.

Implications:

• This case highlights the successful application of DFPP as a perioperative management strategy for cryoglobulinemia patients undergoing CABG.
• The findings suggest that carefully managed cardiopulmonary bypass can be safely performed in patients with cryoglobulinemia.
• This approach may offer a viable option for managing complex cardiac surgeries in patients with this hematological condition.