Emergency off-pump coronary artery bypass grafting for acute left main coronary artery dissection.

We report the case of a 55-year-old woman with multiple comorbid conditions in whom acute left main coronary artery dissection occurred during attempted percutaneous transluminal coronary angioplasty. After the dissection, the patient underwent emergency off-pump coronary revascularization of the left anterior descending coronary artery and ramus intermedius with use of the left internal thoracic artery and a saphenous vein graft, respectively The procedure was successful. The risks and benefits of avoiding the extracorporeal circuit in this case of catheterization laboratory salvage are discussed herein, along with some of the concerns about anesthesia that contributed to our decision to perform the operation off-pump.