[Off-pump coronary artery bypass surgery for the ischemic cardiomyopathy patient with moderate mitral regurgitation and stenosis of bilateral vertebral arteries].

We report a 71-year-old man who had severe coronary and cerebral vascular disease with moderate mitral regurgitation (MR). Left ventricular reconstruction and mitral valve surgery were considered for poor left ventricular function and dilatation with MR. However, low blood pressure during cardiac arrest was risk for stroke due to severe stenosis of bilateral vertebral arteries. The myocardial viability of the anterior wall and inferior wall was confirmed by thallium-201 rest-redistribution single photon emission computed tomography (SPECT). Therefore, off-pump coronary artery bypass grafting (OPCAB) was selected for the patient. Only three Lima sutures were used for keeping the optimal heart position. Coronary anastomoses were done in sequence right gastroepiploic artery (RGEA)-#4 posterior descending (PD), left internal thoracic artery (LITA)-#9-#14 (sequential), RITA-#8 left anterior descending (LAD). No neurological complication occurred postoperatively. Left ventricular function and MR gradually improved. Final ejection fraction (EF) is 51% and MR is trivial. This case demonstrated improvement of MR by only revascularization according to preoperative viability assessment.