Iatrogenic coronary artery injuries during non-coronary artery adult cardiac surgery

Abstract

: The close adjacency of the coronary ostia to the aortic valve, the left circumflex artery to the posterior mitral valve annulus, the right coronary artery to the tricuspid valve, and the septal branch of the left anterior descending artery to the pulmonary valve make them injury prone during surgical interventions on these valves. Iatrogenic coronary artery injuries during non-coronary artery adult cardiac surgery can endanger the myocardium and result in a substantial risk of morbidity and mortality. The clinical presentation of iatrogenic coronary injury is determined by the nature of injury. Acute injuries usually become apparent intraoperatively or immediately postoperatively. Chronic injuries mostly manifest within the first 6 postprocedural months, but they may occur as late as 30 months postoperatively. Prompt diagnosis and timely intervention can salvage the myocardium and improve the prognosis. Intraoperative detection of iatrogenic coronary artery injuries requires a high index of suspicion. The choice of therapeutic strategy, percutaneous coronary intervention or coronary artery bypass grafting, is dictated by the timing of detection as well as the clinical condition of the patient. This review article provides an overview of the incidence, mechanisms, diagnosis and therapeutic strategies to treat iatrogenic coronary artery injuries during non-coronary artery valvular surgery in adults.