A 61-year-old gentleman, known as hypertensive, diabetic and dyslipidemic, presented with chest pain and was diagnosed as Non ST Elevation Myocardial Infarction. His coronary angiogram revealed left main stenosis and chronic total occlusion of left circumflex and mid right coronary artery. His echocardiogram showed moderate left ventricular dysfunction and mild mitral regurgitation. He was taken up for urgent coronary artery bypass grafting.

Surgical Procedure

On cardiopulmonary bypass, he underwent CABG x 9 grafting. Left internal mammary artery anastomosed as a sequential graft to mid and distal left anterior descending artery. Additionally, he had 7 vein grafts anastomosed to two diagonals, two obtuse marginal and three grafts to posterolateral, posterior descending and ventricular branch of right coronary artery. Patient underwent an uneventful recovery postoperatively and was discharged on the seventh post-operative day.

Discussion

This case report highlights the advantages of the often maligned cardiopulmonary bypass in ensuring a complete revascularization in a patient with multiple severe diffuse triple vessel coronary artery disease. Revascularization of all the occluded coronary artery vessels, with as many as nine distal anastomosis, in diffuse coronary artery disease, is highly demanding. With high attrition rates of vein grafts, the utility of complete vascularization cannot be stressed enough. Off-pump revascularization is limited by quality of anastomosis and number of anastomosis.

Complete revascularization in coronary artery disease CABG x 9 grafts