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. 2022 Dec;19(4):199-204.
doi: 10.5114/kitp.2022.122089. Epub 2022 Dec 24.

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

Ivilin Plamenov Todorov  1 , Zdravka Petrova Todorova  2 , Dimitar Petrov Nikolov  1
Affiliations

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

Ivilin Plamenov Todorov et al. Kardiochir Torakochirurgia Pol. 2022 Dec.

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.

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Conflict of interest statement

The authors report no conflict of interest.

Figures

Figure 1
Figure 1
Patent LIMA-LAD graft
Figure 2
Figure 2
The same patient with an occluded LIMA graft using an angioplasty balloon
Figure 3
Figure 3
Number of bypasses performed during the previous operation in group A (with LIMA occlusion)
Figure 4
Figure 4
Number of bypasses performed during the previous operation in group B (without LIMA occlusion)
Figure 5
Figure 5
Preoperative complications in both groups (with and without occlusion) HF – heart failure, RF – renal failure, RsF – respiratory failure.
Figure 6
Figure 6
Catecholamines used in the cessation of CPB
See this image and copyright information in PMC

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