Single stage substernal thyroidectomy and off-pump coronary artery bypass grafting: is it worth using cardiopulmonary bypass unless absolutely necessary?

Abstract

SUMMARYIt is a rare entity to observe the coexistence of thyroid gland pathologies and coronary artery disease, whose surgical treatment may be performed simultaneously. In this case, we present a case of a patient with substernal thyroidectomy concurrent with off-pump coronary artery bypass grafting. A 57-year-old female patient was admitted to the hospital with exertional dyspnoea, intermittent coughing and stable angina pectoris. The substernal goitre measuring 5×5×4 cm was accompanied by a 95% in-stent restenosis at the left anterior descending artery. Thyroidectomy and off-pump coronary artery bypass grafting procedures were performed simultaneously. The postoperative period was uneventful and the patient was discharged 5 days after the operation. This case indicates that off-pump revascularisation seems to be a better option in cases where surgical interventions for thyroid and coronary artery diseases are necessary instead of on-pump revascularisation where the adverse effects of the cardiopulmonary bypass are considered. BACKGROUND

Concomitant off-pump coronary artery bypass grafting and total thyroidectomy for a large retrosternal goitre: a case report and review of the literature

“…As a consequence of this combined approach, normal cardiovascular function and upper airway patency were established, with the patient discharged on postoperative day 10. In the third case report, this same combined procedure was performed on a 57-year-old female with coronary artery disease, which included 95% instent restenosis of the LAD, accompanied by a large retrosternal goitre (9). The reported postoperative period was uneventful and the patient was discharged 5 days later.…”

The evaluation of simultaneous combined surgery of the heart and thyroid - own experience

“…Scientific reports indicate the safety of simultaneous operations on the thyroid gland and coronary artery bypass grafting, inclining at the same time to perform the operation without ECC. This is to reduce the amount of heparin administered -and thus reduce the risk of bleeding [21,22,23] The undoubted downside of simultaneous surgeries is the duration of the procedure. In our case it took about 400 minutes (315-510 minutes) on average, so there is a possibility of excessive cooling of the patient or the occurrence of pressure ulcers.…”

Combined Total Thyroidectomy and Coronary Artery Bypass Grafting: An Endocrine Surgeon Perspective

“…These were mostly reports of an individual case [1][2][3][4][5][6][7][8][9][10][11][12] and a few small case series [13][14][15]. In majority of cases, thyroidectomy was performed due to Retrosternal extension or tracheal compression was the main reason why thyroidectomy was performed together with CABG.…”