Off-pump coronary artery bypass grafting in a patient with moyamoya syndrome: A case report and literature review.

Background: Moyamoya disease is characterized by progressive steno-occlusion of the intracranial vessels, resulting in limited cerebrovascular flow. Cardiac surgery in these patients is uniquely challenging in that cardiopulmonary bypass (CPB) may further compromise cerebral flow and thereby increase the risk of perioperative ischemic events. The preservation of cerebral flow, namely through blood pressure support and controlled carbon dioxide levels, is therefore critically important in this population. Here, we present a case of coronary artery bypass grafting (CABG) in a patient with Moyamoya syndrome and review the literature on perioperative management in this setting. Case Description: A 55-year-old woman with Moyamoya syndrome presented with severe coronary artery stenosis requiring CABG. Given the patient's tenuous cerebrovascular perfusion, which could be further compromised by CPB, the decision was made to perform an off-pump CABG. Normocapnia and stable blood pressure were maintained throughout the procedure. The procedure was completed without neurological complications, and the patient experienced no perioperative ischemic events. Conclusion: This case, along with a review of published adult cardiac surgery cases in patients with Moyamoya disease, highlights the importance of maintaining normocapnia and stable blood pressure in patients with Moyamoya disease undergoing cardiac surgery. Favorable outcomes have been reported when these parameters are preserved, regardless of whether surgery is performed off-pump or with conventional CPB. These findings emphasize the importance of careful management of perioperative hemodynamic and respiratory status to reduce the risk of cerebral ischemic complications in patients with Moyamoya disease undergoing cardiac surgery.