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[Coronary revascularization using profound hypothermia with elective ventricular fibrillation and total circulatory
S Fuwa1, T Tanaka, M Hashimoto
1First Department of Surgery, Gifu University School of Medicine, Japan.
Insights
This study demonstrates the successful use of profound hypothermia and circulatory arrest during coronary artery bypass grafting (CABG) in a patient with severe aortic calcification. This technique enabled complex revascularization, ensuring a positive patient outcome.
Area of Science:
- Cardiovascular Surgery
- Cardiac Anesthesia
- Vascular Biology
Background:
- Severe calcification of the ascending aorta presents a significant challenge during coronary artery bypass grafting (CABG).
- Traditional surgical approaches may be limited by the need for aortic manipulation in calcified segments.
- Unstable angina necessitates timely and effective coronary revascularization.
Observation:
- A 76-year-old female patient with unstable angina required CABG due to severe ascending aorta calcification.
- Coronary arteriography revealed high-grade obstructions in the left anterior descending (LAD) and right coronary artery (RCA).
- A limited non-calcified region in the proximal ascending aorta was identified for aortic cannulation and anastomosis.
Findings:
- Profound hypothermia with elective ventricular fibrillation and total circulatory arrest was employed during CABG.
- An 11-minute period of circulatory arrest was necessary for the proximal saphenous vein graft anastomosis to the aorta.
- The patient was successfully weaned from extracorporeal circulation, with an uneventful postoperative course.
Implications:
- Profound hypothermia and circulatory arrest is a viable strategy for CABG in patients with severe ascending aorta calcification.
- This technique facilitates complex coronary revascularization when standard methods are high-risk.
- Careful patient selection and precise surgical execution are crucial for successful outcomes in challenging aortic conditions.
Abstract:
Profound hypothermia with elective ventricular fibrillation and total circulatory arrest was used in a patient undergoing coronary artery bypass grafting (CABG) with severe calcification of the ascending aorta. A 76-year-old woman with unstable angina was referred for coronary revascularization. Ascending aorta was severely calcified with the exception of limited region of proximal ascending aorta, and the coronary arteriography showed high-grade obstruction of the left anterior descending (LAD) and dominant right coronary artery (RCA). The left internal thoracic artery was anastomosed to the LAD, and the saphenous vein graft to the RCA under systemic moderate hypothermia and elective ventricular fibrillation. During the proximal anastomosis of the saphenous vein graft to the non-calcified ascending aorta, profound hypothermia and circulatory arrest was instituted for 11 minutes. The wean from extracorporeal circulation was successful, and the postoperative course was uneventful.