Recipient Left Internal Mammary Artery Salvage for Donor Coronary Artery Disease during Orthotopic Heart Transplantation: A Case Report and Focused Literature Review.

Donor coronary artery disease (CAD) can lead to the discard of otherwise suitable hearts, although selected focal lesions may be treated with concomitant revascularization. We report orthotopic heart transplantation in a 52-year-old man with end-stage ischemic cardiomyopathy and previous coronary artery bypass grafting using a donor heart in which coronary computed tomography angiography showed severe proximal left anterior descending artery (LAD) stenosis with calcified plaque. Before recipient cardiectomy, the recipient's previously constructed, patent left internal mammary artery (LIMA)-to-LAD graft was carefully mobilized, preserved as an arterial conduit, and repurposed for donor-heart revascularization. After implantation, the salvaged recipient LIMA was anastomosed to the donor LAD distal to the stenosis. Transit-time flow measurement confirmed satisfactory graft function. The patient recovered uneventfully, with preserved biventricular function and angiographic LIMA-LAD patency. This case highlights the technical feasibility of reusing a pre-existing recipient LIMA graft to permit transplantation of a donor heart with focal CAD.