ArticleJournal of cardiology cases2026
A case of off-pump CABG performed in a super-elderly patient with suspected metal allergy and angina.
Article in Journal of cardiology cases, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
The patient was an 86-year-old woman who presented to our hospital with exertional chest pain as her chief complaint. Her medical history was notable for diabetes mellitus. Transthoracic echocardiography revealed reduced wall motion in the lateral and inferolateral walls, with a decreased left ventricular ejection fraction. Although her symptoms improved temporarily with nitrate administration, optimal medical therapy failed to achieve sufficient relief. Coronary angiography showed 90% stenosis in the left anterior descending artery (segments #6-7) and the left circumflex artery (segment #11), along with a chronic total occlusion in the right coronary artery (segment #2). These findings indicated a clear need for coronary revascularization. Subsequent medical history-taking suggested a suspected metal allergy. After heart team conference, off-pump coronary artery bypass grafting (CABG) without the use of metal materials was chosen and successfully performed, due to her advanced age and the allergy concern. Postoperatively, her chest pain resolved completely, and she was discharged in good condition after completing a rehabilitation program. This case highlights the feasibility of off-pump CABG without metallic implants in super-elderly patients with complex coronary artery disease and underscores the importance of individualized, heart team-based decision-making when metal allergy is a concern. Learning objective: This case demonstrates the feasibility of metal-free off-pump coronary artery bypass grafting in a super-elderly patient with complex coronary artery disease. It emphasizes the role of multidisciplinary heart team discussions and shared decision-making when patient-specific concerns, including suspected metal allergy, influence revascularization strategies.
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