Non-anastomotic avulsion of a left internal mammary artery graft - a rare complication of minimally invasive direct coronary artery bypass surgery

a Department of Cardiology, The Royal Brompton and Harefield Hospitals NHS Trust, Harefield Hospital, Hill End Road, Harefield, UB9 6JH, UK b Department of Cardiothoracic Surgery, The Royal Brompton and Harefield Hospitals NHS Trust, Harefield Hospital, Hill End Road, Harefield, UB9 6JH, UK *Corresponding author. Tel.: +44(0) 1895823737; fax: +44(0) 1895828962. E-mail address : a.asherson{at}rbh.nthames.nhs.uk (A.P. Asherson). Objective: To describe a rare complication of minimally invasive coronary artery bypass surgery. Method: Case report. Results: We present a 72-year-old patient with a left anterior descending artery stenosis who underwent elective minimally invasive direct coronary artery bypass (MIDCAB) surgery. Three months post-operatively he developed an anterior chest wall haematoma with electrocardiographic and enzyme evidence of myocardial ischaemia, though without haemodynamic embarrassment. Surgical exploration revealed non-anastomotic avulsion of the LIMA graft, which was bleeding freely into the left hemithorax. Conclusions: Minimally invasive direct coronary artery bypass surgery is now widely practised. Post-operative interruption of the left internal mammary artery graft is uncommon and avulsion of the graft proximal to the anastomosis with the left anterior descending artery has only been described in the literature on three occasions. This complication has been reported once in the setting of conventional bypass surgery and twice in the setting of minimally invasive direct coronary artery bypass surgery. In all of these cases, abrupt graft failure resulted in significant haemodynamic and/or ischaemic compromise, and all occurred within two weeks of surgery. Clinicians should be reminded of this rare though potentially catastrophic complication of MIDCAB surgery. Key Words: MIDCAB; LIMA; Complications