Successful Coronary Artery Bypass Surgery in Extremely poor heart function (low EF 13%) Patient
- drpavankumar
- 0
- on Jan 16, 2017
Mr L.G aged 53 years was admitted on Dec 24, 2016 in Lilavati hospital with Congestive Cardia failure and pulmonary edema. Past history suggested two myocardial infractions in last 3 years and chronic airway obstructive disease due to heavy smoking. Pre admission echocardiography done elsewhere suggested 15% LVEF. Coronary angiography revealed 100% occlusion of LAD and RCA and 90% stenosis of no dominant circumflex coronary artery. In view of this finding PET-Ct scan was done on 30/12/16 to know the viable myocardium. PET-CT scan images suggested significant viable myocardium in anterior, anterolateral and infero-lateral myocardium and entire septum suggesting beneficial cardiac revascularisation to patient.
This high risk CABG was carried out on 3/1/2017. Preoperative Arterial BP 115/80 mmHg, PA pressures were 82/46mmHg and LA (left atrium) pressures were 20/12mmHg suggesting minimal MR. Patient underwent ONPUMP CABG x3 where Left Internal mammary Artery was used for LAD and reversed saphenous vein-graft used for PDA and PLV branches of Right Coronary Artery. Intra aortic balloon pump was used to wean off from cardiopulmonary bypass successfully.
Patient had a smooth recovery thereafter and discharged on 11/1/17 (Post operative echo suggests improvement in heart function to LVEF 25% done on 10/1/17).
This patient’s coronary bypass surgery in extremely poor heart function of EF 13% comes in very high risk category heart surgeries. Normally these patients are candidates for heart transplantation or left ventricular assist device support as bridge to transplant. Due to facts shown by PET-CT scan done on this patient showing viable myocardium, surgical revascularisation was performed. This high risk CABG involves proper pre-surgical preparation of lowering grade III high pulmonary artery pressures while maintaining good systemic blood pressure and short cardio-pulmonary bypass with myocardial protection to carry out full coronary revascularisation. Supported IABP for quick wean off from cardio-pulmonary bypass helps in completion of surgical procedure. Adequacy and benefits of surgical coronary revascularisation can be seen from satisfactory post-operative recovery and improvement of heart function after surgery.