Trial Short Case 3 April 2021

Case Summary

61 year old male presenting with unstable angina and CTO of the LAD

Background

Previous left pneumonectomy for typical carcinoid tumour 2001

Previous PCI to RCA and LCx

Hypertension, Dyslipidaemia

Active bowls player, activity limited by angina, no shortness of breath

Medications

Aspirin

Cilazapril

Metoprolol

ISMN

Atorvastatin

Daily use of GTN spray

Examination

73kg male, 168cm

Posterolateral thoracotomy scar

HSDNM, Displaced apex, no air entry on L)

Bilateral radial Allen's negative, no varicose veins, palpable femoral pulses

Investigations

Echo:

Normal biventricular function and no valve abnormalities

Spirometry; FEV1 1.4 (45%), FVC 2.9 (71%)

Angio: CTO of proximal LAD with filling from RCA, Patent LCx stent, 60% Mid LCx stenosis distal to stent (DFR 1.0), Mild disease proximal RCA

Questions:

What are the indications for surgery in this patient?

What are the key issues in performing coronary artery bypass grafting on this patient?

You decide to offer the patient CABG. What is your operative strategy?