Anaortic off-pump bilateral internal mammary grafting in severe left ventricular dysfunction – Case report

Abstract

A 64 years old male diabetic patient with ejection fraction of 16% and renal dysfunction underwent off-pump CABG using both in situ internal mammary artery grafts. Left internal mammary artery was used to bypass left anterior descending artery and right internal mammary artery was used as composite graft. Patient had uneventful recovery and left ventricular ejection fraction improved to 34% within 8 months after surgery. In presence of left ventricular dysfunction, both internal thoracic artery grafting should be preferred for better patency rate and flow reserve. This is the first ever case report of anaortic off-pump bilateral internal thoracic artery grafting in a patient with left ventricular ejection fraction less than 20%.

Graft Spasm—The Achilles Heel of Arterial Grafts

“…These limit popularity of Harmoncic scalpel among the cardiac surgical fraternity worldwide. Our experience proves that carefully harvested skeletonized arterial graft are safe even in very high risk patients where graft spasm can lead to catastrophy 5 , 6 .…”

Total arterial anaortic off-pump coronary artery bypass grafting in a patient with heart failure – Case report

“…High risk CABG was considered only alternative to medical management or percutaneous coronary intervention (PCI). Myocardial viability study is an important consideration in such patients as excellent result with off-pump CABG is reported before in presence of viable mycardium 1 . However, we could not perform viability study as he was not in a condition to be shifted out of ICU.…”

“…We use both in situ ITA with dual inflow 5 and skeletonized ITA harvesting technique. Skeletonized ITA flow is more than non-skeletonized ITA 1 . ITA has superior flow reserve and patency rate.…”