CASE REPORT   

Chirurgia 2020 February;33(1):48-50

DOI: 10.23736/S0394-9508.19.04938-6

Copyright © 2019 EDIZIONI MINERVA MEDICA

lingua: Inglese

Off pump coronary artery bypass grafting using bilateral internal thoracic arteries in permanent tracheostoma patient

Yoshito SAKON ¹ ✉, Naoto FUKUNAGA ², Tadaaki KOYAMA ²

¹ Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan; ² Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital, Kobe, Japan

Coronary artery bypass grafting (CABG) in a patient with tracheostoma is challenging because the tracheostoma is a significant risk factor for surgical site infections (SSI). Bilateral internal thoracic artery (BITA) harvesting has been also considered as a risk factor. Other risk factors include hemodialysis (HD) and diabetes mellitus (DM). On the other hand, the superiority of BITA in terms of patency and long term results in CABG is generally accepted. It is still controversial issue whether we should choose BITA or single ITA CABG in patients with risk factors of SSI. We report a case of 64-year-old male with a permanent tracheostoma, HD and DM, who underwent CABG. We concentrated on complete revascularization and used BITA by full sternotomy for better long-term results. We used several anti-infection strategies in addition to routine perioperative wound management and there were no wound complications during hospitalization and after 24 months of follow-up.

KEY WORDS: Coronary artery bypass; Thoracic arteries; Tracheostomy; Surgical wound infection