A 68-year-old man with a history of coronary artery bypass graft surgery was admitted for ascending aorta replacement. Preoperative coronary computed tomography angiography revealed occlusion of the three coronary arteries. Perfusion of all three coronary vessels was achieved using a T-graft from the right gastroepiploic and radial arteries, which were anastomosed to the right coronary artery and posterolateral artery, respectively. The patient underwent ascending aorta replacement, with hyperkalemia and hypothermia for myocardial protection. Systemic hyperkalemia was useful to maintain cardiac arrest and also to monitor effective perfusion of the myocardium through the bypass grafts.
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