Paraplegia After Off-Pump Coronary Artery Bypass Grafting

Paraplegia after coronary artery bypass surgery: An uncommon complication in a patient with history of thoracic endovascular aortic repair

“…Among them, paraplegia is one of the rarest, with only a few cases reported in the literature. 1 , 2 , 3 , 4 , 5 In these cases, paraplegia is mainly considered the result of medullary ischemia secondary to systemic hypotension. Other causes include atherosclerotic microembolization as a result of aortic clamping and intra-aortic balloon counterpulsation therapy.…”

Paraplegia Due to Spinal Cord Infarction After Coronary Artery Bypass Graft Surgery

“…The aorta was not manipulated during the surgery. The authors suggested that use of the LIMA as a graft for the anterior descending artery may have caused anterior medullar region ischemia due to loss of its collateral circulation . Elmaci et al reported a case of a 56‐year‐old male who developed paraplegia after on‐pump internal mammary artery grafting.…”

“…Internal mammary artery (IMA) may provide an important collateral blood supply to the spinal cord . Thus, IMA harvesting can lead to an interruption of collateral blood supply to the spinal cord . The use of an IMA as a conduit for CABG surgery should be avoided prior to thoracic aortic aneurysm repair and in those with thoracic aortic disease (degenerative thoracoabdominal aneurysms, aortic dissection) and systemic atherosclerosis.…”

“…The authors suggested that use of the LIMA as a graft for the anterior descending artery may have caused anterior medullar region ischemia due to loss of its collateral circulation. 36 Elmaci et al reported a case of a 56-year-old male who developed paraplegia after on-pump internal mammary artery grafting. The patient had a juxtarenal aortic occlusion, and the authors suggested that harvesting the LITA could have caused loss of medullar collateral circulation and subsequent paraplegia.…”

“…38,40 Thus, IMA harvesting can lead to an interruption of collateral blood supply to the spinal cord. 31,36 The use of an IMA as a conduit for CABG surgery should be avoided prior to thoracic aortic aneurysm repair and in those with thoracic aortic disease (degenerative thoracoabdominal aneurysms, aortic dissection) and systemic atherosclerosis. CABG, coronary artery bypass grafting; IABP, intra-aortic balloon pump; SCN, spinal cord necrosis; TA, thoracic aorta; CT, computed tomography; VSD, ventricular septal defect; ASD, atrial septal defect; HT, hypertension; HITTS, heparin-induced thrombocytopenia and thrombosis syndrome; PVD, peripheral vascular disease; DM, diabetes mellitus; MRI, magnetic resonance imaging; HL, hyperlipidemia; SFA, superficial femoral artery; SLE, systemic lupus erythematosus; AF, atrial fibrillation; CVE, cerebrovascular event; COPD, chronic obstructive pulmonary disease; ICCF, intermittent cross-clamp fibrillation technique; MIDCAB, minimally invasive direct coronary artery bypass; LIMA, left internal mammary artery; LAD, left anterior descending artery; OPCAB, off-pump coronary artery bypass graft surgery.…”