Saphenous Vein Graft Kinking Secondary to Left Atrial Appendage Clip Causing Type 5 Myocardial Infarction.

BACKGROUND

Left atrial appendage (LAA) clip placement is increasingly used for stroke prophylaxis in atrial fibrillation during cardiac surgery. Rare mechanical interactions with adjacent grafts may cause graft failure and type 5 myocardial infarction.

CASE SUMMARY: A 75-year-old man underwent coronary artery bypass grafting with left internal mammary artery to left anterior descending artery and saphenous vein grafts to posterior descending artery and second obtuse marginal branch, with LAA clip placement. On postoperative day 2, he suffered pulseless electrical activity arrest and cardiogenic shock. Angiography revealed graft kinking from clip-related distortion. Percutaneous coronary intervention to the graft failed, and revascularization was redirected to native circumflex artery, restoring normal flow. The patient recovered, with discharge on postoperative day 18.

DISCUSSION: Clip-related complications are rare but important causes of early graft failure. Recognition is critical in postoperative ischemia.

TAKE-HOME MESSAGE: When graft kinking occurs, native-vessel intervention may be a safer strategy.