Intraoperative Cardiac Arrest during Zone 0 Thoracic Endovascular Aortic Repair in a Post-Coronary Artery Bypass Grafting Patient with Bilateral Internal Thoracic Artery Grafts.

An 85-year-old man, with a history of coronary artery bypass grafting (CABG) using bilateral internal thoracic artery (ITA) grafts, underwent zone 0 thoracic endovascular aortic repair (TEVAR) for an aortic arch aneurysm. The procedure involved axillary debranching and the combined use of conventional and fenestrated stent grafts. During deployment of the fenestrated graft, ventricular fibrillation occurred, temporally associated with a transient reduction in brachiocephalic artery blood flow that compromised ITA graft flow. He was discharged without neurological deficits. This case highlights the potentially critical risk of myocardial ischemia during zone 0 TEVAR in post-CABG patients, emphasizing the need for meticulous multidisciplinary planning.