Complex Perioperative Course in a Patient with Neurofibromatosis Type 1 and Severe Left Ventricular Dysfunction Undergoing High‑Risk CABG Surgery

Neurofibromatosis type 1 (NF1) is a multisystem neurocutaneous disorder associated with airway abnormalities, vascular fragility, pulmonary dysfunction, and skeletal deformities, all of which present significant challenges during major cardiac surgery. We describe the case of a 74-year-old male with NF1 and severe ischemic cardiomyopathy (ejection fraction 15%) who underwent high-risk coronary artery bypass grafting with preoperative intra-aortic balloon pump support. Intraoperative difficulties included challenging vascular access, airway abnormalities due to neurofibromas, severe chest wall adhesions affecting graft harvesting, and the need for complex venous graft configurations. His postoperative course was marked by arrhythmias, refractory cardiogenic shock, acute kidney injury requiring continuous renal replacement therapy, and vancomycin-resistant Enterococcus faecium sepsis, culminating in multi-organ failure. This case highlights the intricate anesthetic considerations and high perioperative risk in NF1 patients undergoing complex cardiac surgery and underscores the importance of multidisciplinary perioperative management.