CONGRESS ABSTRACT

Perioperative coronary artery spasm after off-pump coronary artery bypass grafting (OPCAB) is a rare but life-threatening condition. Currently, the etiology of postoperative coronary artery spasm is still to be clearly defined. Despite being  relatively rare (incidence  0.8% to 1.3%), coronary artery spasms can provoke serious complications, including  sudden hemodynamic collapse and death. In this scenario, prompt diagnosis and immediate use of one or more short-term mechanical circulatory support (MCS) devices can be an effective bridge-to-recovery strategy to provide hemodynamic support to the ischaemic myocardium. We report the case of 53-old woman affected by acute coronary artery disease who underwent OPCAB complicated by early massive postoperative spasm of the entire native coronary arteries , ST segment elevation and multiple episodes of ventricular fibrillation.  In order to exclude any acute graft failure, the patient uderwent immediate surgical revision, with graft flow assessment revealing good patency index and flow of all grafts. Due to the unstable hemodynamic condition, a veno-arterial extracorporeal membrane oxigenator (ECMO) was iniziated and urgent coronary angiography was performed, confirming graft patency but revealing severe hypoperfusion of whole native coronary arteries. We proceeded with intracoronary and systemic infusion of vasodilators, resulting in partial improvement of coronary flow, thus confirming the clinical suspect of a rare massive coronary artery spasm. Moreover, we added a further mechanical support – Impella ® 2,5 – to improve left ventricle unloading. The patient recovered in 7 days upon complete resolution of the coronary artery spasm with mechanical support and continuous infusion of vasodilators.