Key result
LAA clip placement during CABG linked to SVG kinking and type 5 MI.
Why the study?
Left atrial appendage clip placement is increasingly used during cardiac surgery, but rare mechanical interactions with adjacent grafts may cause graft failure and type 5 myocardial infarction.
Case Report (n=1)
LAA clip placement during CABG can cause rare mechanical interactions leading to graft kinking and type 5 MI, which may be effectively treated with native-vessel PCI.
LAA clip during CABG may kink grafts causing type 5 MI; leaves open whether intraoperative checks or alternatives are warranted.
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.
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Alhusain et al. (2026) conducted a case report in Type 5 Myocardial Infarction (n=1). Left atrial appendage clip placement was evaluated. Left atrial appendage clip placement during CABG caused saphenous vein graft kinking and type 5 myocardial infarction on postoperative day 2 in a 75-year-old man.
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