A Case of Emergency Off-Pump Coronary Artery Bypass Grafting after DES Stenting

(Department of Cardiovascular Surgery, Fukuoka University, School of Medicine, Fukuoka, Japan)

Hidehiko Iwahashi Tadashi Tashiro Noritsugu Morishige
Yoshio Hayashida Kazuma Takeuchi Nobuhisa Ito
Koji Akasu Go Kuwahara
A 75-year-old man was admitted with symptoms of unstable angina pectoris. The patient was initially treated with ticlopidine and aspirin after first undergoing percutaneous coronary intervention (PCI) by means of a drug eluting stent (DES). Coronary angiography thereafter showed re-stenosis in left main trunk and two-vessel disease. As a result, emergency off-pump coronary artery bypass grafting (OPCAB) was therefore performed. However, major bleeding (3,245ml) occurred after OPCAB. Therefore, a re-thoracotomy operation had to be performed to stop the bleeding. Based on the above findings it is important for surgeons to keep in mind that pre-operative ticlopidine administration can increase the risk of re-operation for hemostasis, while also potentially increasing and the requirements for blood and blood product transfusion both during and after OPCAB surgery.
@Jpn. J. Cardiovasc. Surg. 36: 166-169 (2007)