Heston Napitupulu, Lisca Namretta, Sheila Giusti, Maizul Anwar


Background: Early postoperative graft failure after coronary artery bypass grafting (CABG) is still a significant problem that results in high morbidity and mortality. It is associated with early graft thrombosis, anastomotic stenosis, bypass kinks, overstretching or tension, significant spasm, and incomplete revascularization.
Case Report: 67 years-old male with Coronary Artery Disease involving three vessels (CAD 3VD) underwent CABG surgery. Direct post-operation electrocardiograph (ECG) shown changes in ST segments (elevation on anterior leads and depression on inferior leads) with a significant increase of cardiac markers level. Post-operative coronary angiography revealed an occluded left internal mammary artery (LIMA) graft and native left anterior descending artery (LAD) blockage. Patients’ hemodynamics was not stable, and was urgently underwent an off-pump redo CABG. Intraoperatively we found thrombus at LIMA and saphenous vein graft (SVG) – right coronary artery (RCA) grafts that were caused by atheroma and dissection on anastomotic side. Discussion: The diagnosis of myocardial infarction (MI) remains a clinical challenge since patients are unable to express classic clinical symptoms. Routine ECG combined with cardiac biomarkers are beneficial in diagnosing MI post CABG, and percutaneous coronary angiography (PTCA) is useful in detecting the patency of the grafts. Although percutaneous coronary intervention (PCI) is preferable in the case of anastomosis problem with stable hemodynamic, redo CABG shows more benefit in salvaging infarcted myocardium in patients with unstable hemodynamic. Conclusion: Redo CABG surgery with new or additional grafting may save myocardium and preserve its function in perioperative infarct caused by graft failure.

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Coronary artery bypass grafting; early graft failure; surgery complications.

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Tamer Turk. Early graft failure after coronary artery bypass grafting: diagnosis and treatment. The European Research Journal. 2016;2(2):85-92.

Maxime Laflamme, Nathelie DeMey, et al. Management of early postoperative coronary artery bypass graft failure. Interactive Cardiovascular and Thoracic Surgery. 2012;14:452-456.

Ralf E. Harskamp, Judson B. Williams, et al. Saphenous vein graft failure and clinical putcomes: Toward a surrogate end point in patients following coronary artery bypass surgery?. Am Heart J. 2013 May;165(5):639-643.

Christian Rasmussen, Jens Juel Thiis, et al. Significance and management of early graft failure after coronary artery bpass grafting feasibility and result of acute angiography and re-re-vascularization. European Journal of Cardio-thoracic Surgery. 1997;12:847852.

Tom KW Wang, Ralph AH Stewart, et al. Diagnosis of MI after CABG with high-sensitivity troponin T and new ECG or echocardiogram changes: relationship with mortality and validation of the Universal Definition of MI. European Heart Journal: Acute Cardiovascular Care. 2013;2(4):323-333.