Case Report: Coronary Artery Bypass Graft in Emergent Operative Management of Ballistic Cardiac Trauma
DOI:
https://doi.org/10.70422/91bjjm98Keywords:
Thoracic Trauma, GSW, Coronary Artery Bypass, Cardiac Surgery, Case Report, Coronary Artery Bypass Graft, CABG, Gunshot Wound, Trauma Surgery, Cardiac Trauma, Resuscitative Thoracotomy, Surgery, Cardiopulmonary Bypass, Ballistic Cardiac TraumaAbstract
Introduction
Penetrating cardiac trauma is a rare but highly lethal injury, with prehospital mortality rates exceeding 80%. Advances in trauma resuscitation, surgical intervention, and multidisciplinary collaboration have improved survival rates in select patients. Injuries to the left anterior descending (LAD) artery are particularly devastating, as disruption of coronary circulation can lead to tamponade, ischemia, cardiogenic shock, and rapid deterioration. While traditional management of penetrating coronary injuries often prioritizes hemorrhage control, emerging evidence suggests that coronary artery bypass grafting (CABG) may offer improved outcomes in appropriate candidates.
Case Report
We present a case report of a 32-year-old female who sustained a penetrating cardiac injury with transection of the LAD. The patient was managed at a Level I trauma center with a combined trauma and cardiac surgical approach. Relevant clinical variables, including injury severity, intraoperative decision making, operative interventions, and postoperative outcomes, are presented. The patient underwent immediate bilateral thoracotomy for hemorrhage control, with initial hemostasis achieved through LAD clipping. Intraoperative Cardiac Surgery consultation led to emergent CABG with reverse saphenous vein grafting to restore coronary circulation. The patient tolerated the procedure well, with successful weaning from cardiopulmonary bypass (CPB). Postoperative recovery was favorable, with early ambulation and discharge on postoperative day eight.
Discussion
This case highlights the evolving role of CABG in penetrating cardiac trauma and underscores the importance of rapid intervention and multidisciplinary collaboration.
Conclusion
In select cases of penetrating cardiac injury, aggressive surgical management, including coronary revascularization, may offer improved survival and functional outcomes.
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