Anaortic off-pump bilateral internal mammary grafting in severe left ventricular dysfunction - Case report
Kamales Kumar Saha1, Saurab Goel1, Ajay Kumar1
1Cumballa Hill Hospital and Heart Institute, 93/95 August Kranti Marg, Mumbai 400036, Maharastra, India.
Indian Heart Journal
|October 19, 2016
Summary
This case report highlights successful anaortic off-pump coronary artery bypass grafting using bilateral internal thoracic arteries in a diabetic patient with severe left ventricular dysfunction. The procedure improved ejection fraction, demonstrating the technique
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery
- Thoracic Surgery
Background:
- Severe left ventricular dysfunction poses challenges for coronary artery bypass grafting (CABG).
- Off-pump CABG (OPCAB) offers an alternative to conventional on-pump procedures.
- Internal thoracic artery (ITA) grafts are associated with superior long-term patency rates.
Observation:
- A 64-year-old male diabetic patient with ejection fraction (EF) of 16% and renal dysfunction underwent OPCAB.
- Both in situ left internal thoracic artery (LITA) and right internal thoracic artery (RITA) were utilized.
- LITA bypassed the left anterior descending artery, and RITA was used as a composite graft.
Findings:
- The patient experienced an uneventful recovery post-surgery.
- Left ventricular ejection fraction improved significantly to 34% within 8 months.
- This represents the first reported case of anaortic OPCAB using bilateral ITA grafts in a patient with EF < 20%.
Implications:
- Anaortic OPCAB with bilateral ITA grafting may be a viable option for patients with severe left ventricular dysfunction.
- Utilizing both ITAs can enhance graft patency and flow reserve in high-risk patients.
- This approach warrants consideration for improving outcomes in selected patients with compromised cardiac function.
