Isolated coronary graft perfusion prior to cardiopulmonary bypass during cardiac reoperations: A case report

A 67 year old male presented to our service with angina, syncope, and dyspnea on exertion. He had had a three vessel coronary artery bypass ten years ago and had been asymptomatic until this time. A repeat cardiac catheterization revealed aortic valvular stenosis, left carotid artery stenosis, and restenosis of the left circumflex, anterior descending, and right coronary artery vein grafts. During sternal reentry, the left circumflex graft was inadvertently divided. Shortly thereafter, antero- lateral wall ischemia became evident on the electrocardiogram. The transesophageal echocardiogram revealed acute akinesis of the lateral ventricular wall. The divided graft was cannulated with a 3 mm vessel cannula and secured with a tie. The 4:1 blood cardioplegia system was flushed with a balanced electrolyte solution to remove all cardioplegia solution. Autologous washed red blood cells and homologous packed red blood cells were added to the pump prime. The blood cardioplegia system was used to deliver warm, oxygenated blood to the graft. Graft perfusion was performed for a total of 28 minutes prior to cardiopulmonary bypass. After completion of the surgery the patient was weaned from cardiopulmonary bypass without incident. He had an uncomplicated post-operative course and was discharged from the hospital in good condition.