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[A case of coronary artery bypass grafting with coronary-coronary bypass for familial hypercholesterolemia]
1Department of Cardiovascular Surgery, Mitsui Memorial Hospital, Tokyo, Japan.
Insights
Successful coronary artery bypass grafting using the aortic no-touch technique was performed in a patient with familial hypercholesterolemia and severe aortic calcification. This innovative approach ensured all grafts remained patent, allowing for a successful recovery.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Vascular Biology
Background:
- Familial hypercholesterolemia (FH) poses significant cardiovascular risks.
- Severe ascending aorta calcification presents a surgical challenge for coronary artery bypass grafting (CABG).
- The aortic no-touch technique offers an alternative for CABG in high-risk patients.
Observation:
- A 68-year-old woman with FH and severe aortic calcification underwent CABG.
- The surgical strategy included arterial grafts (left internal thoracic artery, right gastroepiploic artery) and a saphenous vein graft.
- Coronary-coronary bypass was utilized due to aortic calcification and lack of suitable in situ arterial grafts.
Findings:
- The aortic no-touch technique was successfully employed, utilizing fibrillatory arrest and femoral artery perfusion without aortic cross-clamping.
- All bypass grafts (left anterior descending, left circumflex, right coronary artery) demonstrated patency on postoperative angiography.
- The patient was discharged on the 20th postoperative day, indicating a favorable outcome.
Implications:
- This case highlights the feasibility and success of the aortic no-touch technique in complex CABG cases with severe aortic calcification.
- Coronary-coronary bypass can be a viable option when standard grafting is compromised.
- Successful CABG in FH patients with severe aortic calcification underscores advancements in surgical management.
Abstract:
Coronary artery bypass grafting in a 68-year-old woman with familial hypercholesterolemia and severe calcification of the ascending aorta was successfully performed. The left internal thoracic artery bypassed the left anterior descending artery, the right gastroepiploic artery bypassed the left circumflex artery and the saphenous vein graft bypassed the right coronary artery, the proximal anastomosis was based on segment 1 and the distal anastomosis was on segment 3 of the right coronary artery (coronary-coronary bypass). The operation was performed with aortic no touch technique which consisted of fibrillatory arrest without aortic cross-clamping, and femoral artery perfusion. The post operative angiogram revealed patency of all graft, and she discharged at 20th post operative day. Coronary-coronary bypass was took into consideration in a patient with severe calcification of the ascending aorta and without suitable in situ arterial graft.