Emergency on-pump beating heart reconstructive coronary artery bypass grafting for entrapped percutaneous coronary intervention equipment

Background: Equipment entrapment during percutaneous coronary intervention (PCI) may lead to acute ischemia necessitating emergency surgery. Case presentation: This is the first case report where emergency surgery had to be performed on beating heart, for removal of retained PCI equipment, due to an incidental finding of severely atheromatous aorta precluding cross-clamp. Ultrasound-guided aortic cannulation and off-pump strategy made the complex reconstruction of left anterior descending artery possible. Conclusions: PCI equipment entrapment and subsequent myocardial ischemia, with or without hemodynamic compromise, necessitates emergency surgery and should involve an early discussion with a cardiothoracic team. Each case poses different challenges and requires surgical planning to devise an individualized management strategy. Intraoperative finding of atheromatous aorta may be managed with pump-assisted beating heart surgery and clampless technique to achieve satisfactory results.