title: Robotic total endoscopic coronary artery bypass hybrid revascularization procedure in a patient with a preoperative tracheostoma.
abstract: Preoperative tracheostoma presents a significant risk of sternal wound complications, mediastinitis, stoma necrosis and tracheal injury in patients requiring cardiac surgery. Several approaches have been described to limit these risks. Robotic totally endoscopic coronary artery bypass grafting in patients with a tracheostoma has not been reported. We describe a case of completely endoscopic coronary surgery using the daVinci(®) Si™ system in a patient with a tracheostoma. Single left internal mammary artery grafting to the left coronary artery system was carried out successfully as the first stage of a hybrid revascularization and followed by percutaneous coronary intervention to the circumflex coronary artery. We regard this technique as the most minimally-invasive method of surgical coronary revascularization with a significant potential to reduce the risk of mediastinitis in patients with a tracheostoma.
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, University of Maryland Heart Center, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201, USA.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Lehr
authors.forename: Frans S
authors.initials: FS
authors.lastname: van Wagenberg
authors.forename: Reyaz
authors.initials: R
authors.lastname: Haque
authors.forename: Johannes
authors.initials: J
authors.lastname: Bonatti
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation; D003131:Combined Modality Therapy; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D004724:Endoscopy / Q000009:adverse effects / Q000295:instrumentation; D004867:Equipment Design; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008480:Mediastinitis / Q000209:etiology / Q000517:prevention & control; D008670:Metals; D011474:Prosthesis Design; D012371:Robotics / Q000295:instrumentation; D012720:Severity of Illness Index; D015607:Stents; D025321:Surgery, Computer-Assisted / Q000009:adverse effects / Q000295:instrumentation; D014139:Tracheostomy / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D008670:Metals