First Case Of Coronary Artery Bypass Surgery And Baroreflex Activation Device Implantation As A One- Stage Approach
Martin Oberhoffer, Hazem El Beyrouti, Mohamed El Mehsen, Angela Kornberger, Andres Beiras Fernandez, Christian Friedrich Vahl.
Department of Cardiothoracic and Vascular Surgery, Mainz, Germany.
Background Baroreflex activation therapy (BAT) has proven to be a therapeutic option for patients with arterial hypertension (HTN) that persists despite a minimum of 8 weeks of oral antihypertensive medication of at least three different classes, including a diuretic agent. We performed for the first time coronary artery bypass surgery (CABG) and the implantation of a BAT device as a one-stage approach. Concerns may arise regarding additional surgical incisions for carotid artery access and creation of a BAT device pocket after cardiopulmonary bypass. Thus, first aim was to demonstrate safety and feasibility of the procedure. Secondly, we evaluated the postoperative effectivity of the BAT. Method The 78 years old patient was admitted with coronary triple vessel disease and arterial HTN under 5 -fold oral therapy . His medical history consisted of hemodialysis-dependent renal insufficiency and severe peripheral vascular disease with multiple procedures in the past ,including angioplasty and stenting of the left renal artery and both iliac and femoral arteries. Surgical complications and postoperative course was documented and pre- and postoperative 24- hour blood pressure recordings were obtained. Result: The patient underwent CABG using the left internal thoracic artery and a saphenous vein graft followed by the implantation of a BAT device as a one-stage-approach. The patient was extubated within 12 hours and transferred to the regular ward the following day. No surgical site complication or neurologic event occurred, The BAT was activated before discharge to rehabilitation. Systolic/diastolic RR decreased from 170/90 mmHg preoperatively to 141/53 mmHg recorded by 24-h RR-measurement 1 month later. Oral medication remained unchanged. Conclusion: The combined BAT device implantation and CABG is safe and feasible. Follow-up data revealed a substantial reduction in blood pressure. This one stage procedure is a promising option for patients with coronary artery disease requiring surgery and pre-existing therapy- refractory arterial hypertension to prevent further end-organ damage.
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