Article Details

Background: Multivessel coronary artery disease (MV-CAD) often requires coronary artery bypass grafting (CABG), but postoperative complications such as graft failure and myocardial infarction can lead to life-threatening conditions like cardiac arrest, necessitating advanced interventions such as extracorporeal membrane oxygenation (ECMO) and multivessel percutaneous coronary intervention (PCI).
Case Presentation: A 71-year-old male with hypertension and ulcerative colitis underwent three-vessel CABG. Immediately postoperatively, he developed STEMI leading to cardiac arrest, requiring cardiopulmonary resuscitation (CPR) and placement on central VA ECMO. Repeat angiography revealed occlusion of two grafts and complete mid-left anterior descending artery (LAD) occlusion. Emergent PCI revascularized the native coronary vessels with multiple drug-eluting stents (DES) using DK crush technique.
Outcome: The patient was weaned off ECMO after four days and extubated after one week, and had tremendous recovery. Eighteen months later, a repeat angiography for NSTEMI showed patent stents. His left ventricular ejection fraction (LVEF) has improved to 50%.
Conclusion: This case demonstrates the successful management of CABG complications with emergent ECMO and PCI, highlighting the importance of early intervention and a multidisciplinary approach in high-risk patients.

Keywords: Multivessel coronary artery disease; Coronary artery bypass grafting; Extracorporeal membrane oxygenation; Cardiac arrest; Percutaneous coronary intervention; Drug-eluting stents; Postoperative complications