Combined Off-Pump Coronary Artery Bypass and Total Thyroidectomy in a High-Risk Patient With Triple Vessel Coronary Disease and Retrosternal Goiter: A Case Report

Sheikh Muhammad Ahmad Tariq¹, Muhammad Ammar², Ali Salman³, Ahmad Maqsood Quershi⁴, Umar Farooq⁵, Muhammad Tayyeb⁶

Keywords: Off-pump CABG, thyroidectomy, retrosternal goiter, triple vessel disease, combinedsurgery, difficult airway, poliomyelitis

DOI: 10.63475/yjm.v5i1.0277

DOI URL: https://doi.org/10.63475/yjm.v5i1.0277

Publish Date: 25-04-2026

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Pages: 206 - 210

Views: 6

Downloads: 10

Citation: 0

Author Affiliation:

1 Senior Consultant, Cardiac Anaesthesia, National hospital and Medical Center, Lahore, Pakistan
2 Assistant Professor, Cardiac Surgery, Azra Naheed Medical College, Lahore, Pakistan
3 Medical Officer, Anesthesiology, National Hospital and Medical Center, Lahore, Pakistan
4 Consultant, Anesthetist, Nawaz Sharif Social Security Teaching Hospital, Lahore, Pakistan
5 CESR Fellow in Anaesthetic and Pain Management, Queen Elizabeth Hospital, Birmingham, United Kingdom
6 Lecturer, Anesthesiology, Bacha Khan Medical College, Mardan, Pakistan

Abstract

Simultaneous management of complex cardiovascular and endocrine pathology in a single anesthetic exposure presents a significant challenge in high-risk patients. We report a case of a 67-year-old male with severe triple-vessel coronary artery disease and a large retrosternal multinodular goiter causing airway compression. The patient presented with exertional angina (Canadian Cardiovascular Society Class III), dyspnea, progressive neck swelling, hoarseness of voice, and dysphagia. His medical history included hypertension, diabetes mellitus, obesity (body mass index, 32 kg/m²), poor functional capacity, and residual poliomyelitis with bilateral lower-limb weakness. Computed tomography of the neck demonstrated a large retrosternal goiter with tracheal deviation and compression, while coronary angiography confirmed severe triple-vessel disease. Due to the risk of airway compromise and perioperative cardiac ischemia, a multidisciplinary team planned a single-stage surgical approach. Total thyroidectomy was performed first via median sternotomy, followed by Off-pump Coronary Artery Bypass Grafting (OPCABG) using the left internal mammary artery to the left anterior descending artery and a saphenous vein graft to the first obtuse marginal branch. The procedure was conducted under total intravenous anesthesia with invasive monitoring and hemodynamic support. The patient remained hemodynamically stable intraoperatively. Postoperatively, the patient was electively ventilated overnight and successfully extubated the following day after confirming bilateral vocal cord mobility. He was discharged on postoperative day seven without complications. This case demonstrates the feasibility and benefits of a single-stage thyroidectomy and OPCABG in carefully selected high-risk patients.

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