• Eric J Lehr, Frans S van Wagenberg, Reyaz Haque, and Johannes Bonatti.
• Division of Cardiac Surgery, Department of Surgery, University of Maryland Heart Center, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201, USA.
• Interact Cardiovasc Thorac Surg. 2011 May 1; 12 (5): 878-80.

AbstractPreoperative tracheostoma presents a significant risk of sternal wound complications, mediastinitis, stoma necrosis and tracheal injury in patients requiring cardiac surgery. Several approaches have been described to limit these risks. Robotic totally endoscopic coronary artery bypass grafting in patients with a tracheostoma has not been reported. We describe a case of completely endoscopic coronary surgery using the daVinci(®) Si™ system in a patient with a tracheostoma. Single left internal mammary artery grafting to the left coronary artery system was carried out successfully as the first stage of a hybrid revascularization and followed by percutaneous coronary intervention to the circumflex coronary artery. We regard this technique as the most minimally-invasive method of surgical coronary revascularization with a significant potential to reduce the risk of mediastinitis in patients with a tracheostoma.

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