Coronary artery bypass graft surgery during heart transplantation

Area of Science:

• Cardiovascular Surgery
• Organ Transplantation
• Cardiology

Background:

• Heart transplantation is a life-saving procedure for end-stage heart failure.
• Coronary artery bypass graft (CABG) surgery is a common cardiac procedure.
• Donor heart evaluation is critical to ensure graft viability.

Observation:

• During bench preparation for heart transplantation, a significant atherosclerotic lesion was palpated in the donor heart's anterior descending artery.
• This lesion was not identified during the pre-harvesting screening of the donor.
• The patient had a history of prior CABG surgery with a patent internal thoracic artery graft.

Findings:

• The presence of undetected atherosclerosis in a donor heart necessitated intraoperative decision-making.
• The patient's own patent internal thoracic artery was successfully utilized for bypass grafting to the affected coronary artery.
• This approach circumvented the need for immediate intervention on the donor heart's vasculature.

Implications:

• Highlights the importance of thorough intraoperative donor heart assessment beyond standard pre-transplant screening.
• Demonstrates the feasibility of utilizing autologous grafts (patient's own vessels) during transplantation when donor grafts are compromised.
• Suggests a potential strategy for managing unexpected coronary artery disease in donor hearts, optimizing transplant outcomes.