Totally Endoscopic Coronary Artery Bypass Grafting is Feasible in Morbidly Obese Patients
AbstractDevelopment of robotic technology has enabled totally endoscopic coronary artery bypass grafting (TECAB) procedures. With complete preservation of sternal and thoracic stability, this operation would be an interesting option for obese patients, who are known to be at higher risk for deep sternal wound infection. We describe a case of successful totally endoscopic left internal mammary artery to left anterior descending artery bypass grafting using the da Vinci telemanipulation system in a patient who was morbidly obese. The patient underwent a so called staged hybrid coronary intervention with percutaneous angioplasty and placement of a stent to the right coronary artery.
Birkmeyer NJ, Charlesworth DC, Hernandez F, et al. 1998. Obesity and risk of adverse outcomes associated with coronary artery bypass surgery. Northern New England Cardiovascular Disease Study Group. Circulation 97:1689-1694.nDiegler A, Matin M, Falk V, et al. 1999. Indication and patient selection in minimally invasive and off-pump coronary artery bypass grafting. Eur J Cardiothorac Surg 16(Suppl 1):S79-S82.nFeder MT, Patel MB, Melman A, Ghavamian R, Hoenig DM 2008. Comparison of open and laparoscopic nephrectomy in obese and nonobese patients: outcomes stratified by body mass index. J Urol 180:79-83.nKuduvalli M, Grayson AD, Oo AY, Fabri BM, Rashid A 2002. Risk of morbidity and in-hospital mortality in obese patients undergoing coronary artery bypass surgery. Eur J Cardiothorac Surg 22:787-793.nSchachner T, Bonaros N, Feuchtner G, Müller L, Laufer G, Bonatti J 2005. How to handle remote access perfusion for endoscopic cardiac surgery. Heart Surg Forum 8:E232-E235.nSidhu RS, Raj PK, Treat RC, Scarcipino MA, Tarr SM 2007. Obesity as a factor in laparoscopic cholecystectomy. Surg Endosc 21:774-776.nSperlongano P, Pisaniello D, Parmeggiani D, De Falco M, Agresti M, Parmeggiani U 2002. Laparoscopic cholecystectomy in the morbidly obese. Chir Ital 54:363-366.nYap CH, Zimmet A, Mohajeri M, Yii M 2007. Effect of obesity on early morbidity and mortality following cardiac surgery. Heart Lung Circ 161:31-36.n