eISSN: 1897-4252
ISSN: 1731-5530
Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery
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vol. 19
Original paper

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

Department of Cardiac Surgery, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
Department of Endocrinology, Specialized Hospital for Active Treatment of Pediatric Diseases, Faculty of Medicine, Medical University – Sofia, Sofia, Bulgaria
Kardiochirurgia i Torakochirurgia Polska 2022; 19 (4): 199-204
Online publish date: 2022/12/24
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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.

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.

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%.

Our observations suggest that angiographic balloon LIMA occlusion is a reliable, easily applicable and relatively safe technique that improves the surgical results.


prosthetic valve endocarditis, left internal mammary artery occlusion, reoperations, myocardial protection, valve surgery

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