Off-pump coronary artery bypass in a patient with the antiphospholipid syndrome.
Patients with antiphospholipid syndrome (APS) are prone to excessive postoperative morbidity and mortality after cardiovascular surgery because of its thromboembolic derangements. We present a case of coronary artery bypass grafting (CABG) in a patient with primary APS. He suffered from repetitive coronary occlusion after percutaneous transluminal coronary angioplasty (PTCA). Since his lupus anticoagulant level was found to be 217 s (normal, <50 s), he was diagnosed as the primary APS. He received steroid pulsation therapy with 1000 mg of prednisolone, double-filtration plasmapheresis (DFPP) and 50 mg of cyclophosphamide to attenuate the antibody activity. Four months after the last PTCA, he experienced chest pain and approximately 90% of stenosis in the left anterior descending (LAD) lesion was apparent, although the titer for the lupus anticoagulant was reduced to the normal range. He had drug allergy to ticlopidine hydrochloride and aspirin. Taken together, his disease was found to be resistant to these medical treatments, and surgical treatment was considered. Since cardiopulmonary bypass is known to exaggerate its coagulatory and fibrinolytic complications, off-pump CABG (OPCAB) was feasible in this case. The left internal thoracic artery (ITA) was anastomosed to the LAD using the off-pump technique. The procedure was successful, and the postoperative course for 3 years has been satisfactory without any cardiovascular complaints.
Horimoto
S
S
Department of Thoracic and Cardiovascular Surgery, Osaka Medical College, Takatsuki 568-8686, Japan. tho064@poh.osaka-med.ac.jp
Horimoto
H
H
Sawada
Y
Y
Kondo
K
K
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D016736:Antiphospholipid Syndrome / Q000150:complications*; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass / Q000379:methods; D023921:Coronary Stenosis / Q000150:complications / Q000601:surgery*; D006801:Humans; D008297:Male