Angioplasty balloon occlusion of LIMA graft in reoperations of patients
with prosthetic valve endocarditis and patent LIMA-LAD graft
Abstract
Background: Myocardial protection in reoperations in
cardiac surgery is extremely difficult in patients with previous
coronary surgery and a working LIMA-LAD graft, and it largely determines
the outcome of surgery and long-term prognosis. We use a the method of
percutaneous angiographic balloon LIMA occlusion and cardioplegic
arrest. Aims: The aim of this study was to compare the
data of patients with angiographic balloon LIMA-occlusion and those
without occlusion in operations related to PVE, and previous coronary
surgery with permeable LIMA graft, determining the degree of safety and
benefits of method. Study design and Methods: A total of
20 patients undergoing surgery for prosthesis valve endocarditis with
patent LIMA-LAD graft were analyzed retrospectively. We divide 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 (Adrenaline) at the end of CPB. In
group B, the need for double catecholamine maintenance is 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. It was found that the average
duration of mechanical ventilation in group A is 10.5 hours
postoperatively, and in group B - 12.5 hours. The mean duration of
catecholamine infusion in both groups was 3 days. The average stay in
intensive care is shorter for patients in Group A - 2.5 days, and in
Group B is 3.5 days. In terms of survival - mortality in the group with
LIMA occlusion is 0%, while in the group without LIMA occlusion is
20%. Conclusion: Our reported results from the use of
the LIMA balloon occlusion method in patients with prosthetic valve
endocarditis who are high-risk and complicated patients and nevertheless
the mortality in this group studied by us is 0% and no serious
complications of the applied method have been registered. Therefore, we
believe that the angiographic balloon LIMA occlusion is a reliable,
easily applicable and relatively safe technique that improves the
surgical results and prognosis of patients in need of reoperative
cardiac surgery.