Emergency Surgical Treatment for the Total Occlusion of the Left Main Coronary Artery: A Case Report

Background: The acute occlusion of the left main coronary artery (LMCA) in the absence of the collateral circulation is extremely rare, but it remains a catastrophic and mostly fatal entity due to myocardial infarction with severe cardiogenic shock and arrhythmias. Methods: We evaluated 2 patients with an acute or acutely evolving occlusion of the LMCA undergoing coronary artery bypass grafting (CABG). Results: The in-hospital mortality rate was 50%. Revascularization was achieved with on-pump CABG in both patients. Conclusions: The total occlusion of the LMCA represents a unique clinical condition. The LMCA occlusion with shock is regarded as a class IA indication for acute surgical revascularization. Nonetheless, emergent percutaneous coronary intervention (PCI) may be an effective method to acutely revascularize these patients. Additionally, aggressive post-PCI care—including intraaortic balloon pumps, extracorporeal membrane oxygenation, CABG, and ventricular support devices—may be required to improve patient survival.