Off-pump coronary artery bypass for a heparin-allergic patient
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A 46-year-old man with no history of drug allergy developed acute myocardial infarction. Coronary angiographic findings revealed triple vessel disease. Serum hepatic enzymes were elevated due to heparin administered to control infarction, and an allergic reaction developed exclusively due to heparin. To avoid heparin use, we adopted heparin-free off-pump coronary artery bypass grafting through median sternotomy. The systemic anticoagulant agent argatroban was administered to maintain active clotting time over 200 seconds. The left internal thoracic artery was anastomosed to the left anterior descending artery, the radial artery to the diagonal branch, and the right gastroepiploic artery to the right coronary artery. Patency was confirmed by postoperative coronary angiography. No complications were noted. For patients with heparin allergy, off-pump coronary artery bypass grafting is a useful maneuver, because it can be conducted using anticoagulant agents other than heparin.
Key wordsoff-pump CABG heparin allergy
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- 2.Sugawara H, Kumon K, Tanaka K, Egou Y, Naitou T, Fujita T. Evaluation of a synthetic inhibitor MD805 as anticoagulant after open heart and vascular surgery. Kyobugeka 1983; 36: 533–37.Google Scholar
- 3.Fujii H, Kurasako N, Takebayashi T, Tanaka T, Sakano S, Kosogabe Y, et al. Argatroban, a selective thrombin inhibitor for anticoagulant therapy during and following vascular surgery. Masui 1996; 45: 1289–92.Google Scholar
- 4.Endo S, Kawada T, Mieda T, Hozon M, Abe T, Kikuchi T, et al. A clinical study of an antithrombin agent, argatroban for the prevention of platelet loss in left heart bypass with the Bio-medicus centrifugal pump. Jpn J Artif Organs 1995; 24: 513–6.Google Scholar
- 6.Buffolo E, Silva de Andrade JC, Branco JN, Teles CA, Aguiar LF, Gomes WJ. Coronary artery bypass grafting without cardiopulmonary bypass. Ann Thorac Surg 1996; 61: 61–6.Google Scholar
- 8.Gundry SR, Romano MA, Shattuck OH, Razzouk AJ, Bailey LL. Seven-year follow-up of coronary bypasses performed with and without cardiopulmonary bypass. J Thorac Cardiovasc Surg 1998; 118: 12–8.Google Scholar
- 10.Nagasawa H, Fukutake K, Hada M, Takahashi E, Matsubara Y, Samori T, et al. Phase 1 study of synthetic antithrombin agent (MD-805). Single and multiple administration studies. Rinshobyouri 1981; 12: 359–75.Google Scholar