Abstract
Objective: Report of a high risk patient undergoing combined treatment of orthopedic and cardiovascular operations enabling a succesful outcome through a minimally invasive approach. Methods: We report the clinical presentation, medical record, strategies for decision finding and clinical images of a perioperative cardiac infarction during infectious complicated orthopedic re-do surgical treatment that was managed succesfully in a 72 –year –old female high risk patient via minimally invasive direct coronary artery bypass grafting Results: Minimally invasive direct coronary artery bypass grafting represents an excellent revascularization option for patients who are at high risk for sternotomy and cardiopulmonary bypass related complications.This approach enabled the necessary following orthopedic operations and early mobilization of the obese patient resulting in weight loss, enchanced pulmonary function and cure of the infected focus. The minimal invasive coronary artery bypass grafting technique prevented sternal bone instability, infection and facilitated the use of physiotherapy and walking sticks after the orthopedic operation to replace an infected knee prosthesis.The patient could be discharged and presented during follow up in healthy condition with a decrease in body mass index and ability to be fully mobilized. Conclusions: Minimally invasive direct coronary artery bypass grafting represents an excellent revascularization option for patients who are at high risk for sternotomy and cardiopulmonary bypass related complications. Especially patients who suffer from perioperative cardiac infarction who need urgent treatment are suitable for this approach as the internal mamarian artery is used as a graft and no additional bypass graft material is needed. Most patients undergoing revascularization lack of suitable bypass material or require pre-operative evaluations of their vein material. Minimally invasive direct coronary artery bypass grafting shows superior results in the long time follow up when compared to angioplasty and stenting.
Highlights
Coronary artery bypass Surgery can be performed in the high risk patient less invasively by avoiding sternotomy and Cardiopulmonary Bypass (CPB)
Off - pump coronary artery bypass surgery performed through an antero -lateral minithoracotomy termed Minimally Invasive Direct Coronary Artery Bypass Grafting (MIDCAB) is a situable technique for this selected collective of multimorbid patients to prevent sternal wound complications with instability or cardiopulmonary bypass related difficulties especially in the presence of concomitant diseases [1]
Coronary bypass surgery can be performed less invasively by avoiding cardiopulmonary bypass (CPB) and sternotomy as beating heart bypass surgery performed through a minithoracotomy with safe and good postoperative results but patient selection is a crucial criteria for this technically challenging operation [2]
Summary
Coronary artery bypass Surgery can be performed in the high risk patient less invasively by avoiding sternotomy and Cardiopulmonary Bypass (CPB). Off - pump coronary artery bypass surgery performed through an antero -lateral minithoracotomy termed Minimally Invasive Direct Coronary Artery Bypass Grafting (MIDCAB) is a situable technique for this selected collective of multimorbid patients to prevent sternal wound complications with instability or cardiopulmonary bypass related difficulties especially in the presence of concomitant diseases [1]. A 72–year-old female was admitted to our clinic in 2011 with the diagnosis of Perioperative myocardial infarction during explanation of a knee prosthesis following polyarthrosis due to a low grade infection three weeks after insertion of the endoprosthesis on the left side. Following immediately coronary angiography showed tripple vessel disease with subtotal proximal occlusion of the right coronary artery, excentric distal critical stenosis of the left main and proximal subtotal occlusion of the circumflex artery (Figure 1). The right coronary artery showed a proximal 95% stenosis with a distal 75% stenosis, the left main presented with 75 % stenosis , the RIVA(LAD) showed a 50% proximal stenosis and a 75% stenosis in the distal part, the circumflex artery showed a proximal 95% stenosis
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