Ramponi F, Flynn CD, Wilson MK
Heart Lung Circ 2017 Apr;
BACKGROUND: Patients with a permanent tracheostomy requiring coronary surgery represent a unique challenge, being at increased risk of sternal wound complications, mediastinitis and stoma necrosis. Several techniques have been described including manubrium sparing sternotomy, thoracoscopic internal mammary harvest and hybrid revascularization.
HOW TO DO IT: We report a case of robotic assisted (daVinci(®)Xi™ Surgical System) total arterial off-pump revascularization in a patient with previous laryngectomy and permanent tracheostomy. The main advantage of this approach was to minimize the risk of post-operative sternal complication and mediastinatis, whilst still providing the prognostic benefit of total arterial grafting and the neurological advantage of the aorta no-touch technique.