Iatrogenic Coronary Artery Compromise Post Non-Coronary Cardiac Surgery in Patients With Normal Coronaries

Abstract

<jats:p>Background: Unexpected events in cardiac surgery may increase morbidity and mortality. We present rare complications related to coronary arteries in non-coronary cardiac surgery in adults and pediatrics.&#x0D; Patients and Methods: We retrospectively reviewed our surgical left-sided valve procedures and aortic root reconstruction for patients with documented coronary ostial injury or left circumflex artery (LCX) between January 2012 and December 2019.&#x0D; Preoperative echocardiography was the standard investigation for all cases and other specific work ups were ordered, according to each case. Management by surgical or non-surgical intervention was planned, according to each complication. Postoperative hemodynamics and mortality rate were the outcomes of interest.&#x0D; Results: Seven patients were found to have coronary artery compromise post left-sided valve procedures and aortic root reconstruction in adults and children. The details are shown in Table 1. The complications were in 2 patients post-mitral valve (MV) repair, 3 patients post-aortic (AV) replacement, 2 pediatric patients, 1 post-aortic homograft, and the other post-repair of anomalous single coronary arising from the pulmonary artery (ASCAPA). Six patients were hemodynamically unstable. Five patients had intraoperative ischemic changes on electrocardiogram and echocardiography, while ventricular arrhythmias were documented in 3 patients. Two patients were treated with percutaneous coronary intervention to LCX and right coronary artery (RCA), while 4 patients required immediate surgery to graft the obtuse marginal branch of the LCX artery (1) and RCA (3). No revision to valvular procedure was done. With the exception of one, all patients survived.&#x0D; Conclusion: A high index of suspicion is required to diagnose and rescue coronary complications post-valvular surgery and aortic root reconstruction.</jats:p>

Reply to: “Coronary injury post valve surgery: don't miss intraoperative diagnosis” by Khaled Ebrahim Al‐Ebrahim, FRCSC

“…We would like to thank Professor Al‐Ebrahim 1 for his letter regarding our case report of an acute coronary occlusion after surgical replacement of the aortic valve 2 . We read with interest their previous series of iatrogenic coronary artery compromise post cardiac surgery 3 . The authors advocate a prompt diagnosis and percutaneous treatment of this type of complication.…”

“…2 We read with interest their previous series of iatrogenic coronary artery compromise post cardiac surgery. 3 The authors advocate a prompt diagnosis and percutaneous treatment of this type of complication. In our case, we obtained a clear and prompt diagnosis of postoperative ischemia immediately after coming off cardiopulmonary bypass with obvious ECG changes and transoesophageal echocardiographic findings of hypokinesia.…”

Coronary injury postvalve surgery: Do not miss the intraoperative diagnosis

“…To the Editor, We read with interest the case report by Ackah et al 1 We previously reported, in a cohort study, 2…”