Angioplasty balloon occlusion of LIMA graft in reoperations of patients with prosthetic valve endocarditis and patent LIMA-LAD graft
Ivilin Plamenov Todorov, Zdravka Petrova Todorova, Dimitar Petrov Nikolov, Ivilin Plamenov Todorov, Zdravka Petrova Todorova, Dimitar Petrov Nikolov
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).
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References
- Yau TM, Borger MA, Weisel RD, Ivanov J. The changing pattern of reoperative coronary surgery: trends in 1230 con-secutive reoperations. J Thorac Cardiovasc Surg 2000; 120: 156-163.
- Borger MA, Rao V, Weisel RD, Floh AA, Cohen G, Feindel CM, et al. . Reoperative coronary bypass surgery: effect of patent grafts and retrograde cardioplegia. J Thorac Cardiovasc Surg 2001; 121: 83-90.
- Grinda JM, Latremouille CP, D’Attellis N, Berrebi A, Fabiani JN. Angioplasty balloon occlusion of internal thoracic artery in redo surgery in patients with coronary artery bypass operations. J Thorac Cardiovasc Surg 2001; 122: 182-183.
- Velissaris T, Khan O, Asopa S, Calver A, Ohri S. Myocardial protection during reoperative cardiac surgery early experience with a new technique. Tex Heart Inst J 2010; 37: 75-78.
- Byrne JG, Aranki SF, Adams DH, Rizzo RJ, Couper GS, Cohn LH. Mitral valve surgery after previous CABG with functioning IMA grafts. Ann Thorac Surg 1999; 68: 2243-2247.
- Karavas AN, Byrne JG. Continuous retrograde cardioplegia simplifies aortic valve replacement in the presence of a patent internal mammary artery: reply. Ann Thorac Surg 2003; 76: 1338.
Source: PubMed