Successful Coronary Artery Bypass Grafting in a patient with Hereditary Hemorrhagic Telangiectasia
Nosayaba Enofe, Hakan Orbay, Charles M. Geller
Crozer Chester Medical Center, Philadelphia, PA, USA
OBJECTIVE: To review coronary artery bypass grafting (CABG) in hereditary hemorrhagic telangiectasia (HHT). To date little is known about CABG in this patient population.
METHODS: An extensive patient chart review and literature search was conducted. Only a handful of studies were identified in the literature. We reviewed in detail the patient's history, physical examination and perioperative events. HHT pathophysiology and natural history reported in other patient populations were juxtaposed on CABG patients. We describe a 65 year old male with HHT and multiple medical comorbidities including hypertension, diabetes mellitus, chronic obstructive pulmonary disease and morbid obesity who presented at out institution with unstable angina and underwent a successful on pump CABG x 3 utilizing bilateral internal mammary arteries and saphenous vein graft. Standard perioperative heparin and aminocaproic acid dosing was administered.
RESULTS: Hereditary hemorrhagic telangiectasia or Osler Weber Rendu syndrome is a rare genetic vasculopathy that usually manifests with abnormal bleeding from mucosal surfaces. Coronary artery bypass grafting in this patient population is largely unstudied. There are no specific guidelines or recommendations regarding the perioperative management of this patient population in the literature. Although life threatening hemorrhage has been described in patients with HHT, we did not observe an increased risk of surgical bleeding with standard perioperative management following CABG.
CONCLUSIONS: Based on the limited case reports in the literature and our own experience, hereditary hemorrhagic telangiectasia does not seem to increase the risk of surgical site bleeding following coronary artery bypass grafting
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