Myocardial protection during reoperative cardiac surgery: early experience with a new technique

Abstract

We recently introduced a new adjunct to myocardial preservation in patients with a patent left internal mammary artery graft who were undergoing reoperative cardiac surgery. The purpose of this study was to review our early experience with this technique.The technique consists of preoperative insertion of a suitably sized angioplasty balloon catheter into the proximal part of the graft under fluoroscopic guidance. Intraoperative inflation of the balloon results in occlusion of the graft during aortic cross-clamping. We have used this technique in 9 patients. The case records of these patients were retrospectively reviewed. There were 5 men and 4 women with a mean age of 71 +/- 11 years and a mean Euro-SCORE of 10 +/- 3. The median time interval from previous cardiac operation to reoperation was 6 years (interquartile range, 2-11 yr). After the balloon catheter was inserted successfully into the left internal mammary artery graft, the balloon was inflated intraoperatively for successful occlusion of the graft in all patients. There was no in-hospital death, and no significant complications were observed.The early results of this technique seem favorable. A prospective randomized study is needed in order to evaluate the potential advantages of this method over other techniques of myocardial protection during cardiac reoperations.

Keywords: Angioplasty balloon; catheterization, peripheral; coronary artery bypass; graft occlusion, vascular; internal mammary artery; reoperation/methods; vascular patency.

Fig. 1 A 15 × 2.5-mm balloon (black arrows) over the guidewire (white arrows) has been temporarily inflated in the proximal segment of the internal mammary artery graft.