{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T05:11:52Z","timestamp":1778130712550,"version":"3.51.4"},"reference-count":23,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2025,8,16]],"date-time":"2025-08-16T00:00:00Z","timestamp":1755302400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Perfusion"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Traditional cardioplegia strategies often fail in cases with patent coronary grafts due to continuous myocardial perfusion, this necessitates for alternate approaches such as systemic hyperkalemic cardiac arrest. During redo cardiac surgeries, a patent left internal mammary artery (LIMA) might prevent the heart from maintaining electrical cardiac arrest. Induced systemic hyperkalaemia is a novel approach to maintain cardiac electromechanical arrest.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case summary<\/jats:title>\n                    <jats:p>We report a case of 66\u00a0year-old male with a history of Post CABG for Triple vessel disease (TVD) who required mini-thoractomy for left atrial myxoma excision. Given the existence of patent coronary grafts, attaining cardiac arrest with standard cardioplegia was not possible, necessitating the use of systemic hyperkalaemia for myocardial arrest. The patient was placed on Femoro-femoral cardiopulmonary bypass (CPB) and cooled to 20\u00b0C. To induce myocardial arrest, multiple potassium boluses were delivered, totalling 120\u00a0mEq\/L potassium chloride (KCl) over multiple stages. Despite high potassium levels (6.7\u00a0mEq\/L in the third arterial blood gas), CPB was successfully weaned off, and the surgical recuperation went smoothly. This case highlights the complexities of myocardial protection in redo cardiac surgery and underscores the role of systemic hyperkalaemia, perfusion management, ultrafiltration, and careful electrolyte management in such high-risk settings. To the best of our knowledge this is the first documented case report of its kind internationally. While there are previous reports of left atrial myxoma excision in post-CABG patients, including those managed using ventricular fibrillation, this is the first reported case in which systemic hyperkalemia combined with deep hypothermia was successfully utilized via a mini-thoracotomy approach in a post-CABG patient with a patent LIMA graft, without the use of aortic cross-clamping or ventricular fibrillation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case shows the complexities of myocardial protection in redo cardiac surgeries with patent grafts. The use of systemic hyperkalemia is a viable but challenging alternative to cardioplegia, requiring meticulous potassium management and close hemodynamic monitoring.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/02676591251367870","type":"journal-article","created":{"date-parts":[[2025,8,16]],"date-time":"2025-08-16T10:26:56Z","timestamp":1755340016000},"page":"478-484","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Staged systemic hyperkalemia and deep hypothermia for myocardial protection in mini-thoracotomy reintervention: Preserving patency in post-CABG patent grafts"],"prefix":"10.1177","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-2120-2525","authenticated-orcid":false,"given":"Manoj","family":"Sadasivan","sequence":"first","affiliation":[{"name":"Caritas Hospital"},{"name":"& Institute of Health Sciences"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rajesh M","family":"Ramankutty","sequence":"additional","affiliation":[{"name":"Caritas Hospital"},{"name":"& Institute of Health Sciences"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7200-5332","authenticated-orcid":false,"given":"Jecco","family":"Ani Babu","sequence":"additional","affiliation":[{"name":"Caritas Hospital"},{"name":"& Institute of Health Sciences"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nisha","family":"Joseph Pattani","sequence":"additional","affiliation":[{"name":"Caritas Hospital"},{"name":"& Institute of Health Sciences"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sari","family":"Sankaran Lilli","sequence":"additional","affiliation":[{"name":"Caritas Hospital"},{"name":"& Institute of Health Sciences"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jose Sasidharan","family":"Lilli","sequence":"additional","affiliation":[{"name":"Caritas Hospital"},{"name":"& Institute of Health Sciences"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aiswarya","family":"Mohan","sequence":"additional","affiliation":[{"name":"Caritas Hospital"},{"name":"& Institute of Health Sciences"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,8,16]]},"reference":[{"issue":"3","key":"e_1_3_5_2_2","first-page":"228","article-title":"Left atrial myxoma following coronary artery bypass grafting with patient coronary arterial grafts: a rarity","volume":"32","author":"Patel K","year":"2017","unstructured":"Patel K, Rahul K, Tarsaria M, et al. Left atrial myxoma following coronary artery bypass grafting with patient coronary arterial grafts: a rarity. Braz J Cardiovasc Surg 2017; 32(3): 228\u2013230.","journal-title":"Braz J Cardiovasc Surg"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.1067\/mhj.2000.107176"},{"issue":"32","key":"e_1_3_5_4_2","first-page":"11","article-title":"Cardiac myxomas: a review of current treatment approaches and emerging molecular therapies","volume":"22","author":"Ashinze P","year":"2024","unstructured":"Ashinze P, Banerjee S, Egbunu E, et al. Cardiac myxomas: a review of current treatment approaches and emerging molecular therapies. Cardiothorac Surg 2024; 22(32): 11.","journal-title":"Cardiothorac Surg"},{"key":"e_1_3_5_5_2","doi-asserted-by":"publisher","DOI":"10.4330\/wjc.v14.i4.206"},{"issue":"2","key":"e_1_3_5_6_2","first-page":"217","article-title":"Inducing systemic hyperkalemia for cardiac arrest during cardiopulmonary bypass with patent cardiac circulation","volume":"35","author":"Panjwani A","year":"2022","unstructured":"Panjwani A, Patel MJ, Youngblood C, et al. Inducing systemic hyperkalemia for cardiac arrest during cardiopulmonary bypass with patent cardiac circulation. SAVE Proc 2022; 35(2): 217\u2013218.","journal-title":"SAVE Proc"},{"issue":"2","key":"e_1_3_5_7_2","article-title":"Induced hyperkalemic arrest vs. ventricular fibrillation for minimally invasive mitral valve replacement: a case report","volume":"9","author":"Basha JW","year":"2006","unstructured":"Basha JW, Dewitt RC, Jones GP. Induced hyperkalemic arrest vs. ventricular fibrillation for minimally invasive mitral valve replacement: a case report. Internet J Thorac Cardiovasc Surg 2006; 9(2), Available from: https:\/\/ispub.com\/IJTCVS\/9\/2\/5541","journal-title":"Internet J Thorac Cardiovasc Surg"},{"key":"e_1_3_5_8_2","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-195709000-00012"},{"key":"e_1_3_5_9_2","doi-asserted-by":"publisher","DOI":"10.1113\/jphysiol.1883.sp000120"},{"key":"e_1_3_5_10_2","doi-asserted-by":"publisher","DOI":"10.3389\/fphys.2013.00228"},{"key":"e_1_3_5_11_2","doi-asserted-by":"publisher","DOI":"10.1051\/ject\/2024027"},{"key":"e_1_3_5_12_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13019-023-02209-1"},{"key":"e_1_3_5_13_2","volume-title":"StatPearls","author":"Kamassai JD","year":"2025","unstructured":"Kamassai JD, Lowery DR. Retrograde cardioplegia. In: StatPearls. Treasure Island (FL): StatPearls Publishing, 2025. Available from: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK538289\/"},{"key":"e_1_3_5_14_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8191.2008.00680.x"},{"key":"e_1_3_5_15_2","unstructured":"Systemic Hyperhalemia for Cardicc Arresa on CPB with or without Crosscross\u2010cng - Ramanathan - 2008. Journal of Cardiac Surgery - Wiley Online Library [Internet]. [cited 2025 Mar 20]. Available from."},{"key":"e_1_3_5_16_2","doi-asserted-by":"publisher","DOI":"10.4103\/aca.ACA_71_20"},{"key":"e_1_3_5_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5223(95)70195-8"},{"issue":"5","key":"e_1_3_5_18_2","first-page":"438","article-title":"Resection of left atrial myxoma in a patient with retrosternal gastric tube: a case report","volume":"32","author":"Pomerantzeff PMA","year":"2017","unstructured":"Pomerantzeff PMA, Veronese ET, Dinato FJ, et al. Resection of left atrial myxoma in a patient with retrosternal gastric tube: a case report. Braz J Cardiovasc Surg 2017; 32(5): 438\u2013441.","journal-title":"Braz J Cardiovasc Surg"},{"issue":"6","key":"e_1_3_5_19_2","first-page":"674","article-title":"Cerebral perfusion in aortic arch surgery: antegrade, retrograde, or both?","volume":"38","author":"Lee TY","year":"2011","unstructured":"Lee TY, Safi HJ, Estrera AL. Cerebral perfusion in aortic arch surgery: antegrade, retrograde, or both? Tex Heart Inst J 2011; 38(6): 674\u2013677.","journal-title":"Tex Heart Inst J"},{"key":"e_1_3_5_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.xjon.2021.05.020"},{"issue":"1","key":"e_1_3_5_21_2","first-page":"44","article-title":"Temperature management in cardiac surgery","volume":"2013","author":"Saad H","year":"2013","unstructured":"Saad H, Aladawy M. Temperature management in cardiac surgery. Glob Cardiol Sci Pract 2013; 2013(1): 44\u201362.","journal-title":"Glob Cardiol Sci Pract"},{"key":"e_1_3_5_22_2","doi-asserted-by":"publisher","DOI":"10.1510\/icvts.2010.233262"},{"key":"e_1_3_5_23_2","doi-asserted-by":"publisher","DOI":"10.1510\/icvts.2010.233262"},{"key":"e_1_3_5_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2010.03.032"}],"container-title":["Perfusion"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/02676591251367870","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/02676591251367870","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/02676591251367870","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T04:23:35Z","timestamp":1778127815000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/02676591251367870"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,16]]},"references-count":23,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,5]]}},"alternative-id":["10.1177\/02676591251367870"],"URL":"https:\/\/doi.org\/10.1177\/02676591251367870","relation":{},"ISSN":["0267-6591","1477-111X"],"issn-type":[{"value":"0267-6591","type":"print"},{"value":"1477-111X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,16]]}}}