Minimally Invasive Cardiac Surgery for Spontaneous Coronary Artery Dissection

Published evidence on coronary artery bypass grafting for spontaneous coronary artery dissection (SCAD) is limited, and the optimal surgical strategy for SCAD has not yet been established. We herein report a case of SCAD treated with minimally invasive cardiac surgery coronary artery bypass grafting (MICS-CABG). This is the first case of SCAD treated with MICS-CABG in the literature.

The patient was a 50-year-old man who was admitted to the emergency room with sudden chest pain. Emergent coronary angiography revealed double-lumen findings in the left main trunk (LMT). We diagnosed him with SCAD and decided to treat him conservatively. However, his troponin I (5549 pg/mL) and creatine kinase (533 U/L) levels increased, and coronary CTA (CCTA) revealed that the true lumen of the LMT was compressed to 75% stenosis on the next day. We performed MICS-CABG with the left internal thoracic artery (LITA) anastomosed to the left anterior descending branch via a small left thoracotomy, because the myocardial infarction was impending. The operation time was 182 min, and intraoperative blood loss was 368 mL. The postoperative course was uneventful. The SCAD lesion improved completely, and the LITA was patent on re-evaluation 3 months after surgery.

In patients with a relatively stable hemodynamic status, MICS-CABG is a feasible and effective therapeutic approach for SCAD.