Related Experiment Videos
[Coronary revascularization for patients requiring steroids. A report of three cases]
Insights
Steroid use in patients undergoing coronary artery bypass grafting (CABG) poses risks, particularly with saphenous vein grafts. Arterial grafts show better patency and durability in these complex cases, suggesting careful conduit selection is crucial for improved outcomes.
Area of Science:
- Cardiology
- Cardiothoracic Surgery
- Pharmacology
Context:
- Systemic diseases requiring steroid therapy present unique challenges for cardiac surgery.
- Coronary artery bypass grafting (CABG) in steroid-dependent patients necessitates careful anesthetic and surgical management.
- The impact of long-term steroid use on graft patency and patient outcomes after CABG is not fully understood.
Purpose:
- To report on the anesthetic and surgical management of three patients with systemic diseases requiring steroids who underwent CABG.
- To evaluate the patency and durability of different bypass conduits (saphenous vein vs. arterial grafts) in steroid-dependent patients.
- To discuss the potential adverse effects of steroid administration on graft integrity and long-term outcomes.
Summary:
- Three cases of CABG in steroid-treated patients are presented, highlighting anesthetic considerations and management strategies.
- Histological examination revealed saphenous vein grafts were fragile, potentially due to steroid use, while arterial grafts remained patent and healthy.
- Patient outcomes varied, with two patients discharged free of angina, but one succumbed to multiple organ failure, underscoring the complexity of managing these patients.
Impact:
- Findings suggest that arterial grafts may be superior to saphenous vein grafts in patients requiring long-term steroid therapy due to improved patency and reduced fragility.
- Careful selection of bypass conduits is a critical factor in optimizing outcomes for steroid-dependent patients undergoing CABG.
- This study contributes to understanding the risks and management strategies for CABG in immunocompromised patients, informing clinical decision-making and future research.
Abstract:
Three patients with systemic disease requiring steroids, in whom coronary artery bypass grafting (CABG) was performed, are reported in this paper, Anesthetic problems and operative managements for such patients are also discussed. Patient 1, 57-year-old male with thrombocytosis underwent emergency double CABG using saphenous vein and the Bioflow graft. He discharged with freedom from angina. Patient 2, 59-year-old male with polymyositis who had been receiving steroid for 10 years underwent quadruple CABG using bilateral internal thoracic arteries with sequential technique and the Bioflow graft, but he died of multiple organ failure on 16 days after operation. Postmortem examination revealed that coronary artery sclerosis progressed more severely than we had expected from angiography. All the graft anastomosed were completely patent. Histological examination showed that the saphenous vein was fragile. The pathological changes might be due to steroid administration. On the other hand, arterial grafts were completely normal. Patient 3, 37-year-old male with idiopathic thrombocytopenic purpura who had been on steroids underwent combined triple CABG using internal thoracic artery, gastroepiploic artery and the Bioflow graft and splenectomy. He discharged with freedom from angina and tendency to bleed. Postoperative angiography showed both arterial grafts were well patent and left ventricular wall motion vastly improved. From our experience, a careful consideration of the bypass conduit is a major problem in such patients requiring steroids.