Concomitant Off-pump Cabg And Beating Heart Mvr In A Patient With Stent Occlusion And Severe Mr And Poor Lv Function
Himansu K. Dasmahapatra, Esq., Partha P. Rana, Basudev Bhattacharya, Alok Mazumder.
BR Singh Hospital, Kolkata, India.
OBJECTIVE: Cardiac reperfusion injury is a well described complication occurring after ischemia or following cardioplegic arrest. This reperfision injury can become more pronounced in patient with poor LV ejection fraction. Various strategies have been developed to prevent ischemic repercussion injury. We report a patient with intracoronary stent occlusion, severe mitral regurgitation (MR) and poor LV function who had undergone concomitant off-Pump CABG (OPCAB) and MVR in beating heart without aortic X-clamping
METHODS: A 55 yrs old diabetic gentleman developed acute myocardial infarction, thrombolysed with STK/TNR and after couple of months PTCA and Stenting with DES was performed for a critical proximal LAD stenosis. After couple of months he presented with cardiogenic shock, acute shortness of breath requiring mechanical ventilation. Once the cardiac condition improved, the patient was weaned from ventilatory support. 2-D echo Doppler studies revealed globally hypokinetic LV dysfunction (EF less than 30 percent), grade IV MR, severe PAH (PASP =92 mmHg, with no aortic regurgitation. Because of poor general condition no repeat coronary angiography was performed and the patient was submitted for urgent MVR and CABG even though it was assumed that his DES could be patent.Through a median sternotomy incision OPCAB was performed with SVG distal to DES. There was no antegrade flow following LAD arteriotomy. Following OPCAB, MVR was performed in beating heart without aortic X- clamping with preservation of posterior leaflet.
RESULTS: The patient was weaned from CPB with no inotropic support and his post operative course was uneventful and discharged on 8th postoperative days. His follow up reports after six months were satisfactory.
CONCLUSIONS: We conclude that the patient with severe MR and associated critical coronary stenosis or coronary stent occlusion and severely impaired LV function, can undergo concomitant OPCAB and on- pump beating mitral valve surgery with a good clinical outcome
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