Awake off-pump no-touch aorta coronary artery bypass grafting in a patient with interstitial lung disease during the COVID-19 pandemic

Mehmet Sanser Ates, Zumrut Tuba Demirozu

Abstract

Background: Off-pump coronary artery bypass grafting (OPCABG) is favoured to reduce surgical trauma during myocardial revascularisation. Severe chronic respiratory conditions, such as interstitial lung disease, are known to significantly complicate perioperative management and long-term survival. For patients with a history of serious chronic respiratory or advanced respiratory disease, awake OPCABG under high thoracic epidural anaesthesia (TEA) provides a highly beneficial alternative to conventional general anaesthesia.
Case presentation: A 71-year-old male with a 10-year history of chronic interstitial pulmonary fibrosis presented with exertional dyspnoea. Coronary angiography and transthoracic echocardiography revealed two-vessel disease. Based on preoperative pulmonary function tests and the high risk of prolonged endotracheal intubation, the patient was deemed a high-risk candidate for general anaesthesia. In July 2020, during the COVID-19 pandemic, he underwent awake off-pump no-touch aorta double coronary artery bypass grafting using arterial revascularisation under TEA. The patient's recovery was uneventful, and he was discharged on the fifth postoperative day.
Conclusion: Awake OPCABG under TEA is a viable strategy for elderly patients with severe interstitial lung disease who face substantial risks from conventional cardiopulmonary bypass. This complex approach should be restricted to referral centres with extensive experience in advanced off-pump surgery and thoracic epidural anaesthesia.