Angioplasty balloon occlusion of LIMA graft in reoperations of patients with prosthetic valve endocarditis and patent LIMA-LAD graft

Abstract

Introduction: Myocardial protection in reoperative cardiac surgery is extremely difficult in patients with previous coronary surgery and a working LAD-LIMA graft. We use the method of percutaneous angiographic balloon left internal mammary artery (LIMA) occlusion and cardioplegic arrest.

Aim: To compare the data of patients with angiographic balloon LIMA-occlusion and those without occlusion in operations related to prosthetic valve endocarditis (PVE), and determine the degree of safety and benefits of the method.

Material and methods: A total of 20 patients undergoing surgery for PVE with a patent LIMA-LAD graft were analyzed retrospectively. We divided the patients into 2 groups: group A - patients with LIMA occlusion; and group B - patients without LIMA occlusion. The pre-, intra- and postoperative results were compared and the degree of safety and benefits of the application of the method were studied.

Results: 80% of patients in group A needed only dopamine infusion and 20% needed the addition of a second catecholamine at the end of CPB. In group B, the need for double catecholamine maintenance was noted in 50% of patients. The need for implantation of an intra-aortic balloon pump due to refractory heart failure was registered in 10% of patients in group A and in 20% of patients in group B. In terms of survival, mortality in the group with LIMA occlusion was 0%, while in the group without LIMA occlusion it was 20%.

Conclusions: Our observations suggest that angiographic balloon LIMA occlusion is a reliable, easily applicable and relatively safe technique that improves the surgical results.

Keywords: left internal mammary artery occlusion; myocardial protection; prosthetic valve endocarditis; reoperations; valve surgery.

Conflict of interest statement

The authors report no conflict of interest.

Copyright: © 2022 Polish Society of Cardiothoracic Surgeons (Polskie Towarzystwo KardioTorakochirurgów) and the editors of the Polish Journal of Cardio-Thoracic Surgery (Kardiochirurgia i Torakochirurgia Polska).

Figures

Figure 1

Patent LIMA-LAD graft

Figure 2

The same patient with an occluded LIMA graft using an angioplasty balloon

Figure 3

Number of bypasses performed during the previous operation in group A (with LIMA occlusion)

Figure 4

Number of bypasses performed during the previous operation in group B (without LIMA occlusion)

Figure 5

Preoperative complications in both groups (with and without occlusion) HF – heart failure, RF – renal failure, RsF – respiratory failure.

Figure 6

Catecholamines used in the cessation of CPB