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Intrathecal Morphine for Analgesia in Robotic Totally Endoscopic Coronary Artery Bypass and Myocardial Bridge Unroofing

Published:October 26, 2022DOI:https://doi.org/10.1053/j.jvca.2022.10.020
      A 43-year-old man had a past medical history of coronary artery disease with drug-eluting stents placed in 2016 in the midleft anterior descending (LAD) and proximal diagonal artery. He eventually developed severe in-stent stenosis of the diagonal stent and underwent angioplasty in 2018. He remained stable until early 2021 when he presented to an emergency room with severe angina after exertion. A left heart catheterization at that time demonstrated patent stents. However, in the months following his emergency room visit, his symptoms worsened such that he had severe angina and dyspnea with minimal exertion; a repeat left heart catheterization in September 2021 revealed 90% in-stent stenosis of the previously angioplastied diagonal stent, and a new 90% stenosis in the proximal LAD. The patient was referred for coronary artery bypass grafting, and he selected totally endoscopic coronary artery bypass (TECAB) to avoid sternotomy.

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