Off-pump myocardial revascularization in a high-risk patient with essential thrombocythemia

Coronary artery bypass graft for stent occlusion in a patient with essential thrombocythemia

Essential thrombocythemia (ET) is a rare myeloproliferative disorder characterized by pathologic expansion of the megakaryocytic elements in the bone marrow leading to persistent thrombocytosis and platelet dysfunction. The incidence of coronary artery disease can reach 9.4% and this is accompanied by high incidence of acute myocardial infractions. There are no clear guidelines for best management approach to these patients when cardiac surgery is planned. A case of ET required coronary artery bypass graft surgery for stent occlusion is presented with careful preoperative planning leading to full recovery with no complications.

Polycythaemia Vera and Coronary Artery Bypass Graft Surgery: A Systematic Review of the Literature

OBJECTIVES

Polycythaemia vera (PV) is a condition that may potentially put patients undergoing cardiac surgery at an increased risk of bleeding and thrombosis; however, there is currently a paucity of literature regarding the management of these patients. We aim to examine the literature in this systematic review to indicate the interventions that may be considered to minimise complications.

METHODS

We conducted a literature search using keywords and MeSH terms to identify articles discussing PV and cardiac surgery. The studies were identified and qualitatively analysed using the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) protocol.

RESULTS

In total, 10 case reports representing 11 patients were identified for this systematic review and were included in qualitative analysis. 63.6% of patients had preoperative intermittent phlebotomy, and the majority of patients received postoperative therapy that involved one antiplatelet and one anticoagulant. Generous perioperative fluid management, phlebotomy, preservation of core body temperature, early extubation, monitoring of myocardial ischaemia, infarction and vascular events, intense chest physiotherapy and patient mobilisation are important to consider to reduce the risk of complications arising from surgery.

CONCLUSION

These considerations should be systematically discussed in a multidisciplinary team, where the acute surgical need can be balanced appropriately against the risk of haemorrhage and thrombosis.

Thrombosis of Coronary Arteries in a Patient With Polycythemia Vera During the Myocardial Revascularization: A Case Report

Introduction

Coronary artery bypass grafting in a patient suffering from polycythemia vera is clinically rare and extremely challenging. There is no established protocol regarding the management of these patients because the number of patients in this circumstance is very small. Expressed thrombotic risk in patients suffering from polycythemia vera is highly emphasized in patients with coronary artery disease. Only a few cases have been reported of performing coronary artery bypass grafting, and in those cases a successful outcome seems to be an exception.

Case presentation

We report a case of a 73-year-old male caucasian patient suffering from frequent daily chest pain and unstable angina with a 75% stenosis of the left main coronary artery and a subocclusion of proximal right coronary artery undergoing coronary artery bypass grafting, where despite following all the management algorithms and hematologic and cardiologic guidelines properly during the preoperative workup, the patient had a complex postoperative recovery with thrombosis of native coronary vessels—the left anterior descending artery and right coronary artery.

Conclusion

Further investigation is needed regarding the effect of deciding between strategies in the domain of cardiac surgery as well as in the hematologic domain on the final outcome. It would be absolutely necessary to conduct a global trial to investigate the preferred cardiosurgical procedure (OPCAB or on-pump CABG).

Pulmonary Artery Catheter Thrombus in a Patient With Essential Thrombocytosis: A Case Report

Essential thrombocytosis (ET) is a rare chronic myeloproliferative disorder characterized by elevated platelet counts. The management of patients with ET undergoing coronary artery bypass graft remains unclear. Often, patients who are deemed "high risk" for thrombotic events receive cytoreductive therapy before surgery, while patients deemed "low risk" do not receive cytoreductive therapy. Here, we present a case of a patient with ET with only a mild elevation in platelets deemed "low risk" for thrombotic complications who was found to have a small intracardiac thrombus around the pulmonary artery catheter before initiation of cardiopulmonary bypass.

Aortic valve replacement with essential thrombocythemia

Cardiac surgery in patients with essential thrombocythemia carries the risks of both thrombotic events and a bleeding tendency. We report the case of a 75-year-old man with essential thrombocythemia who underwent successful surgical aortic valve replacement after his platelet count was controlled with plateletpheresis 3 times before surgery.