Coronary Artery Bypass Graft in Six Members of a Family: A Case Series

Document Type : Case Report


1 Cardio Surgeon, Department of Cardiovascular Surgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

2 Cardio Surgeon, Department of Cardiovascular Surgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

3 Dermatologist, Department of Dermatology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

4 Student Research Committee, Faculty of Medicine, Islamic Azad University, Mashhad Branch, Mashhad, Iran.

5 Msc in Medical Surgical Nursing Education, Research Assistant of Department Of Cardiovascular Surgery, Faculty Of Medicine, Mashhad University Of Medical Sciences.

6 Anaesthesiologist, Department of Anaesthesiology, Faculty Of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran


Abstract: Coronary artery disease (CAD) is a multifactorial problem. Although hyperlipidemia (HLP), diabetes (DM), and hypertension (HTN) are known as the familial and cardiac risk factors, CABG is rare in the several members of a family. We reported the six members of a family who presented with MI and/or advanced angina pectoris during the 6 years. CABG(Coronary artery bypass graft) considered for all patients due to involvement in main coronary arteries and clinical presentation. The ejection fraction (EF) was varied between 25% to 70%. Beating heart cardiopulmonary bypass (beating heart CPB) and off-pump were chosen as surgical method. The mean duration of surgery was about 4 hours. The only post-operative complication was deep wound infected in a young man who was smoker and drug abuser. According to family relationship of patients and the high effect of genetic penetration, we presume the gene influence to incidence CAD and potential to undergoing CABG, in members of a special family.


1. Mao C, Howard TD, Sullivan D, Fu Z, Yu G, Parker SJ, Will R, Vander Heide RS, Wang Y, Hixson J, Van Eyk J. Bioinformatic Analysis of Coronary Disease Associated SNPs and Genes to Identify Proteins Potentially Involved in the Pathogenesis of Atherosclerosis. Journal of proteomics and genomics research. 2017;2(1):1.
2. Nikpay M, Goel A, Won HH, Hall LM, Willenborg C, Kanoni S, Saleheen D, Kyriakou T, Nelson CP, Hopewell JC, Webb TR. A comprehensive 1000 Genomes–based genome-wide association meta-analysis of coronary artery disease. Nature genetics. 2015 Oct;47(10):1121.
3. Pai, C.C., Lin, Y.W., Tsai, Y.T., Loh, S.H., Lin, C.Y., Lin, C.S., Lin, Y.C., Ke, H.Y., Lin, F.Y. and Tsai, C.S., 2017. A Thrombomodulin Gene Polymorphism (C1418T) Is Associated with Early Outcomes in Patients Undergoing Coronary Artery Bypass Graft Surgery with a Conventional Cardiopulmonary Bypass during Hospitalization. Medicines, 4(2), p.22.
4. Yanagawa B, Algarni KD, Singh SK, Deb S, Vincent J, Elituv R, Desai ND, Rajamani K, McManus BM, Liu PP, Cohen EA. Clinical, biochemical, and genetic predictors of coronary artery bypass graft failure. The Journal of thoracic and cardiovascular surgery. 2014 Aug 1;148(2):515-20.
5. Pustavoitau, A., Barodka, V., Sharpless, N.E., Torrice, C., Nyhan, D., Berkowitz, D.E., Shah, A.S., Roche, K.J.B. and Walston, J.D., 2016. Role of senescence marker p16INK4a measured in peripheral blood T-lymphocytes in predicting length of hospital stay after coronary artery bypass surgery in older adults. Experimental gerontology, 74, pp.29-36.
6. McPherson R, Tybjaerg-Hansen A. Genetics of coronary artery disease. Circulation research. 2016 Feb 19;118(4):564-78.
7. Al Suwaidi J, Hamasaki S, Higano ST, Nishimura RA, Holmes DR, Lerman A. Long-term follow-up of patients with mild coronary artery disease and endothelial dysfunction. Circulation. 2000 Mar 7;101(9):948-54.
8. Cvetkovic, D., Lafaro, R., Giamelli, J., Suvro, S., Erb, M. and Yaghoubian, S., 2016, June. Quadruple vessel coronary artery bypass grafting in a 14-year-old child with plasminogen activator inhibitor-1 4G/4G gene polymorphism. In Seminars in cardiothoracic and vascular anesthesia (Vol. 20, No. 2, pp. 163-167). Sage CA: Los Angeles, CA: SAGE Publications.
9. Nicolini F, Fortuna D, Contini GA, Pacini D, Gabbieri D, Zussa C, De Palma R, Vezzani A, Gherli T. The Impact of Age on Clinical Outcomes of Coronary Artery Bypass Grafting: Long-Term Results of a Real-World Registry. BioMed Research International. 2017;2017.
10. Saw J. Coronary angiogram classification of spontaneous coronary artery dissection. Catheterization and Cardiovascular Interventions. 2014 Dec 1;84(7):1115-22.
11. Wang Q. Molecular genetics of coronary artery disease. Current opinion in cardiology. 2005 May;20(3):182.
12. Alexander JH, Smith PK. Coronary-artery bypass grafting. New England Journal of Medicine. 2016 May 19;374(20):1954-64.
13. Eagle KA, Guyton RA, Davidoff R, Edwards FH, Ewy GA, Gardner TJ, Hart JC, Herrmann HC, Hillis LD, Hutter AM, Lytle BW. ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for Coronary Artery Bypass Graft Surgery). Circulation. 2004 Oct 5;110(14).
14. Polomsky M, He X, O’Brien SM, Puskas JD. Outcomes of off-pump versus on-pump coronary artery bypass grafting: impact of preoperative risk. J Thorac Cardiovasc Surg 2013;145:1193–8.
15. Keeling WB, Williams ML, Slaughter MS, Zhao Y, Puskas JD. Off-pump and on-pump coronary revascularization in patients with low ejection fraction: a report from the Society of Thoracic Surgeons National Database. Ann Thorac Surg 2013;96:83–9.
16. Chawla LS, Zhao Y, Lough FC, Schroeder E, Seneff MG, Brennan JM. Off-pump versus on-pump coronary artery bypass grafting outcomes stratified by preoperative renal function. J Am Soc Nephrol 2012;23:1389–97.