Related Experiment Video
Updated: May 17, 2026
Surgical Porcine Model of Chronic Myocardial Ischemia Treated by Exosome-laden Collagen Patch and Off-pump Coronary Artery Bypass Graft
Published on: September 15, 2023
Residual Graft Pathology During CABG as a Minimally Invasive Diagnostic Pathway for Transthyretin Amyloidosis
Asuka Kuwahara1, Atsushi Okada1, Kenta Yamaguchi1
1Department of Heart Failure and Transplantation, National Cerebral and Cardiovascular Center, Osaka, Japan.
Insights
Diagnosing cardiac amyloidosis (CA) with coronary artery disease is challenging. Residual arterial graft tissue from bypass surgery offers a novel, minimally invasive method for confirming CA, especially when other tests are inconclusive.
Area of Science:
- Cardiology
- Pathology
- Vascular Surgery
Background:
- Cardiac amyloidosis (CA) often coexists with coronary artery disease (CAD), complicating diagnosis.
- Myocardial ischemia in CA can interfere with standard diagnostic tests like bone scintigraphy.
- Endomyocardial biopsy, a common diagnostic tool, carries procedural risks.
Background:
Concomitant coronary artery disease is not uncommon in cardiac amyloidosis (CA), yet diagnostic pathways remain challenging when myocardial ischemia and CA coexist.
Case Summary:
We describe a 72-year-old man presenting with heart failure and severe 3-vessel disease in whom transthyretin amyloidosis was ultimately diagnosed using residual arterial graft tissue obtained during urgent coronary artery bypass grafting (CABG). Histologic examination of the residual left and right internal thoracic arteries and radial artery revealed transthyretin amyloidosis amyloid deposition, enabling rapid, minimally invasive confirmation of systemic amyloidosis at a time when bone scintigraphy risked false-positive interpretation due to myocardial ischemia and endomyocardial biopsy posed a procedural risk. The patient demonstrated marked clinical improvement after CABG and was started on vutrisiran.
Discussion:
This case highlights arterial graft pathology as a practical and rarely used diagnostic opportunity for suspected CA in patients undergoing CABG, suggesting a potential role for graft-based screening in selected individuals.
Take-Home Messages:
Residual arterial graft tissue obtained during CABG may provide a practical, minimally invasive means of confirming systemic amyloidosis when nonbiopsy pathways may be inconclusive or endomyocardial biopsy poses procedural risk.
