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Successful on-pump coronary artery bypass without using protamine.

Vivek Srivastava¹, Palanikumar Saravanan, Jeanette Abraham

¹Department of Cardiothoracic Surgery, Victoria Hospital, Blackpool, United Kingdom.

The Annals of Thoracic Surgery

|January 25, 2011

Summary

This case report details managing a patient with critical coronary artery disease and a protamine allergy. Heparin without protamine was successfully used during coronary artery bypass grafting (CABG).

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Area of Science:

Cardiology
Cardiac Surgery
Anesthesiology

Background:

A 48-year-old female patient presented with symptoms of angina and exertional dyspnea.
Diagnosis revealed critical left main stem coronary artery disease and a blocked right coronary artery.
The patient had a known allergy to protamine, a common heparin reversal agent.

Observation:

Multidisciplinary consultation was essential for treatment planning.
Heparin reversal without protamine was chosen as the management strategy.
The patient underwent successful on-pump coronary artery bypass grafting (CABG).

Findings:

The procedure was performed without excessive intraoperative blood loss.
A notable disadvantage was the extended total operating time.
Achieving normal coagulation required the use of blood products.

Implications:

This case highlights a viable strategy for CABG in patients with protamine allergy.
It demonstrates the successful use of heparin without protamine reversal in complex cardiac surgery.
Careful management and potential use of blood products should be considered in similar cases.