Cardiac protection with systemic hyperkalemia in reoperations with patent grafts

Area of Science:

• Cardiovascular Surgery
• Vascular Grafting
• Myocardial Protection

Background:

• A 68-year-old male patient with prior coronary artery bypass graft (CABG) surgery required ascending aorta replacement.
• Preoperative assessment revealed complete occlusion of all three major coronary arteries.

Observation:

• A complex T-graft reconstruction was performed utilizing the right gastroepiploic artery and the radial artery.
• These grafts were meticulously anastomosed to the right coronary artery and the posterolateral artery, respectively, to restore coronary perfusion.

Findings:

• The patient successfully underwent ascending aorta replacement.
• Myocardial protection was achieved through induced hypothermia and systemic hyperkalemia, which facilitated controlled cardiac arrest.
• Hyperkalemia also served as a valuable tool for monitoring the effectiveness of the bypass grafts in perfusing the myocardium.

Implications:

• This case highlights the successful application of a T-graft strategy using visceral and peripheral arteries for complex coronary revascularization during aortic surgery.
• The use of hyperkalemia for myocardial protection and perfusion monitoring offers a potential adjunct in complex cardiac procedures.
• This approach may offer an alternative for patients with extensive coronary artery disease undergoing major aortic interventions.