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midcab-facilitates-combined-curative-treatment-in-the-high-risk-patient.pdf

Winkler Bernhard, Zappe Bjorn, Ludovic Melly, Bremerich Jens, Grapow Martin, Eckstein Friedrich and Reuthebuch Oliver

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.