Coronary surgery with diabetes and severe hemophilia B is a challenging situation requiring specific and adequate therapeutic considerations. We herein report the case of a 52-year-old diabetic patient with severe factor IX deficiency and impaired ventricular function, who was scheduled for myocardial revascularization because of exertional angina and recurrent myocardial infarctions following infusions of factor IX concentrate. The patient underwent a successful off-pump direct myocardial revascularization with neither hemorrhagic nor thrombotic complications. Hematological protocols and operative strategies are assessed and discussed.

Early repair of postinfarction ventricular septal rupture is usually associated with significant mortality and morbidity. Assessing conditions to moderately delay the surgical intervention and reduce cardioplegic arrest may be an interesting approach to improve hospital results. Results of five non-selected patients in whom surgery was moderately delayed and performed according a policy of reducing the cardioplegic-induced ischemia were reviewed. Surgical options are discussed as well as observed advantages.

Time-consuming and complex cardiac surgery remains a challenge in patients with impaired ventricular function and consequently necessary prolonged cardioplegic arrest may jeopardize a fragile myocardial status. The case is reported of a 63-year-old male patient with low left ventricular ejection fraction (LVEF) and history of refractory cardiac failure who successfully underwent a beating heart aortic and mitral valve replacement through a superior biatrial septotomy. Technical considerations and advantages related to this specific surgical access combined with a beating heart approach are discussed.

We report the case of a 66-year-old male with increasing angina occurring after two previous coronary artery surgery procedures. The second operation had been complicated by severe mediastinitis necessitating surgical drainage, and sternal stabilization. Angiography revealed an occlusion of the LAD bypass with a patent LAD associated with a stenotic circumflex coronary artery. The ascending aorta was severely calcified. An off-pump axillo-LAD coronary artery bypass was safely performed in conjunction with stenting of the circumflex artery. This approach dramatically simplified the procedure and reduced the operative risk. At the 52-month follow-up, the patient is free of any angina symptoms.