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
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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.

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血管成形术球囊闭塞LIMA移植物在人工瓣膜心内膜炎患者再手术中的应用。
导语:对于既往冠状动脉手术和有效的LAD-LIMA移植的患者,再手术心脏手术中的心肌保护是极其困难的。我们采用经皮血管造影球囊阻断左乳内动脉(LIMA)并发心脏骤停的方法。目的:比较血管造影球囊封堵与未封堵的患者在人工瓣膜心内膜炎(PVE)相关手术中的资料,确定该方法的安全性和获益程度。材料与方法:回顾性分析20例PVE手术伴LIMA-LAD未专利移植物的患者。我们将患者分为两组:A组- LIMA闭塞患者;B组为无LIMA闭塞的患者。比较术前、术中和术后的结果,并研究该方法应用的安全性和获益程度。结果:A组80%的患者只需要多巴胺输注,20%的患者需要在CPB结束时添加第二次儿茶酚胺。在B组中,50%的患者需要双儿茶酚胺维持。A组10%的患者和b组20%的患者因难治性心力衰竭而需要植入主动脉内球囊泵。在生存方面,LIMA闭塞组的死亡率为0%,而未LIMA闭塞组的死亡率为20%。结论:我们的观察结果表明,血管造影球囊闭塞术是一种可靠、易于应用且相对安全的技术,可提高手术效果。
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来源期刊
CiteScore
0.90
自引率
14.30%
发文量
44
审稿时长
6-12 weeks
期刊介绍: Polish Journal of Thoracic and Cardiovascular Surgery is a quarterly aimed at cardiologists, cardiosurgeons and thoracic surgeons. Includes the original works (experimental, research and development), illustrative and casuistical works about cardiology and cardiosurgery.
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