Our Summary

This research paper discusses the difficulties faced when patients with chronic tracheostoma - a permanent hole in the windpipe - need a specific type of heart surgery called coronary bypass surgery. These patients have a higher risk of developing infections in the chest bone wound. To counter this, the paper suggests using a less invasive technique called minimally invasive coronary artery bypass grafting (MICS CABG). This technique can fully restore blood flow to the heart while reducing the risk of chest bone complications and physical decline linked to traditional surgery. It could be a suitable alternative for these high-risk patients. The study presents a case of a weak patient with multiple health issues, a chronic tracheostomy, and severe heart disease not suitable for non-surgical therapy, who was referred for MICS CABG.

FAQs

  1. What is Minimally Invasive Coronary Artery Bypass Grafting (MICS CABG)?
  2. Why is MICS CABG a viable strategy for patients with chronic tracheostoma?
  3. What are the benefits of MICS CABG for patients at high risk of sternal wound infections (SWI)?

Doctor’s Tip

A doctor may tell a patient with chronic tracheostoma who requires coronary artery bypass surgery that minimally invasive coronary artery bypass grafting (MICS CABG) is a robust technique that allows complete surgical revascularization while reducing the risk of sternal wound infections. This approach may be a viable option to avoid sternotomy and its associated complications in high-risk patients. It is important to discuss with your healthcare provider to determine the best course of treatment for your specific situation.

Suitable For

Patients who are typically recommended for coronary artery bypass surgery include those with symptomatic multivessel coronary artery disease that is not amenable to percutaneous therapy, as well as those at elevated risk for sternal wound infections or other complications associated with traditional sternotomy. Frail or comorbid patients, such as those with chronic tracheostoma, may benefit from minimally invasive coronary artery bypass grafting (MICS CABG) to reduce the risks of sternal complications and functional decline. It is important for healthcare providers to carefully assess each patient’s individual risk factors and overall health status to determine the most appropriate revascularization strategy.

Timeline

Before coronary artery bypass surgery:

  1. Patient presents with symptoms of angina/chest pain and is diagnosed with multivessel coronary artery disease.
  2. Patient may undergo diagnostic tests such as angiography to confirm the extent of blockages in the arteries.
  3. Patient undergoes pre-operative evaluation to assess fitness for surgery, including evaluation of comorbidities such as chronic tracheostoma.
  4. Surgical team determines the most appropriate revascularization strategy, considering the patient’s individual risk factors.

After coronary artery bypass surgery:

  1. Patient undergoes minimally invasive coronary artery bypass grafting (MICS CABG) as a surgical revascularization strategy.
  2. Surgery is performed through small incisions, reducing the risk of sternal wound infections and promoting faster recovery.
  3. Patient is closely monitored in the post-operative period for any complications and to ensure successful revascularization.
  4. Patient undergoes cardiac rehabilitation to aid in recovery and improve overall cardiovascular health.
  5. Long-term follow-up is conducted to monitor the patient’s progress and ensure the success of the bypass surgery in improving symptoms and overall cardiac function.

What to Ask Your Doctor

Some questions a patient should ask their doctor about coronary artery bypass may include:

  1. What are the potential risks and complications associated with coronary artery bypass surgery?
  2. How will this surgery improve my symptoms and quality of life?
  3. Are there any alternative treatment options available for my condition?
  4. How long is the recovery process after coronary artery bypass surgery?
  5. Will I need to make any lifestyle changes or take medications after the surgery?
  6. What is the success rate of this type of surgery for patients with my specific condition?
  7. Will I need any additional follow-up care or monitoring after the surgery?
  8. How experienced is the surgical team in performing minimally invasive coronary artery bypass surgery?
  9. What are the specific benefits of minimally invasive coronary artery bypass surgery compared to traditional sternotomy?
  10. How can I best prepare for the surgery and optimize my chances of a successful outcome?

Reference

Authors: Nantsios A, Elmistekawy E, Ponnambalam M, Lambert AS, Ruel M. Journal: Innovations (Phila). 2022 Nov-Dec;17(6):574-576. doi: 10.1177/15569845221137898. Epub 2022 Dec 26. PMID: 36571255