Minimally Invasive Coronary Artery Bypass Grafting in a Patient With Chronic Tracheostoma: Alternative to Reduce Sternal Wound Complication Risk

Abstract

Patients with chronic tracheostoma present a challenge when they require coronary bypass surgery due to an elevated risk of sternal wound infections (SWI). Minimally invasive coronary artery bypass grafting (MICS CABG) is a robust technique that allows complete surgical revascularization while mitigating the risks of sternal complications and functional decline associated with sternotomy. In such patients at elevated risk for SWI, MICS CABG may represent a viable revascularization strategy to avoid sternotomy. Here, we present a case of a frail, comorbid patient with a chronic tracheostomy and symptomatic multivessel coronary artery disease not amenable to percutaneous therapy referred for MICS CABG.

Early and long-term outcomes of less invasive approaches to coronary artery bypass surgery

“…Guo et al also reported functional outcomes to supplement and strengthen the investigated clinical outcomes [18] . Of the patients who completed the questionnaire, 12 (2.8%) had > CCS Class II angina and 19 (4.5%) reported having > NYHA Class II symptoms.…”

“…Additionally, MICS CABG is employed in cases of left main coronary artery disease with normal right coronary artery disease, previous unsuccessful PCIs, triple vessel disease with medium to large PDA or left ventricular branch of the RCA, and complex proximal left-sided lesions in the presence or absence of main branch involvement [17] . Patients with less diffuse coronary artery may elect to undergo MICS CABG due to its reduced invasiveness and improved functional outcomes [18] . Furthermore, for patients who are at high risk of complications related to sternotomy, such as those with chronic tracheostoma or diabetes [5,19] , MICS CABG could be an attractive alternative.…”

“…A recent prospective study conducted by Guo et al investigated the 12-year survival, major adverse cardiac and cerebrovascular events, revascularization, and function outcomes in an all-inclusive cohort from a single center [18] . A total of 566 patients who underwent MICS CABG were followed for survival.…”

“…The MICS Repeat revascularization and repeat revascularization for graft failure cumulative incidence for patients who underwent minimally invasive coronary artery bypass grafting, accounting for death as a competing risk. Confidence Interval: 95%; Revasc: repeat revascularization; Graft-Revasc: revascularization for graft failure [18] .…”

“…Early improvement in functioning potentially Freedom from all-cause mortality or MACCE for patients who underwent MICS CABG in a 12-year period. Confidence Interval: 95%; MACCE: major adverse cardiac and cerebrovascular events; MICS CABG: minimally invasive coronary artery bypass grafting [18] .…”