[Spinal cord infarction due to aortic dissection during coronary artery bypass grafting under percutaneous...

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Medical Device Complications

Background:

• Coronary artery bypass grafting (CABG) is a common procedure for treating severe coronary artery disease.
• Percutaneous cardiopulmonary support (PCPS) is utilized to maintain circulation during complex cardiac surgeries.
• Ensuring correct cannula placement is vital for patient safety during extracorporeal circulation.

Observation:

• A 77-year-old male undergoing off-pump CABG (OPCAB) experienced sudden hypotension during grafting.
• PCPS was initiated using a left femoral artery cannula, leading to bradycardia and subsequent diagnosis of Stanford type A aortic dissection via transesophageal echocardiography.
• Neurological deficit manifested as bilateral leg paralysis post-operatively.

Findings:

• The aortic dissection was directly attributed to the malpositioned PCPS femoral artery cannula.
• Conversion of the PCPS perfusion site to the right axillary artery resulted in the resolution of the false lumen and aortic dissection.
• Magnetic resonance imaging (MRI) confirmed spinal cord infarction secondary to the aortic dissection.

Implications:

• This case highlights the critical importance of meticulous attention to the arterial cannula's site and size during PCPS in CABG procedures.
• Proper cannula management can prevent life-threatening complications such as aortic dissection and associated neurological damage.
• Standardization of protocols for PCPS cannulation may reduce the incidence of such adverse events in cardiac surgery.