Preoperative Intra-aortic Balloon Support in Surgery for Left Main Coronary Stenosis

Abstract

Twenty-six patients with left main coronary (LMC) stenosis were operated upon with preoperative intra aortic balloon pump (IABP) support. There was no mortality, and no morbidity attributable to the balloon catheter. The most delicate facet of revascularization surgery in this entity is the pre-cardiopulmonary bypass phase including anesthesia induction during which blood pressure fluctuation may further diminish severely compromised coronary flow. Although systolic pressure dropped to below 100 mm Hg in 50% of patients during induction, there were only two patients with electrocardiographic evidence of perioperative myocardial infarction, and only one who needed rantic institution of cardiopulmonary bypass just after induction. Perioperative logistics were quite trouble free in all 26 patients, in marked contrast to 5 LMC patients operated upon prior to our preoperative IABP concent; 3 of these deteriorated upon induction, with two deaths resulting. Preoperative IABP is a reasonable supportive adjunct in surgery for LMC stenosis.

O uso do balão intra-aórtico no pré-operatório de cirurgia de revascularização miocárdica, associada à disfunção ventricular grave

“…17 , in a case series, reported that the prophylactic use of the balloon in revascularization surgery in the presence of left coronary trunk lesion was a safe strategy, with no increment of vascular complications. The surgical results were adequate and comparable to those obtained in lower risk surgeries.…”

Hanging by a thread—urgent coronary artery bypass grafting for ST elevation myocardial infarction in a patient with isolated left main coronary artery disease

“…14 If the patient is hemodynamically unstable or continues to have chest pain prior to urgent revascularization (either surgically or percutaneously), mechanical support (with an intra-aortic balloon pump or percutaneous left ventricular assist device) may be helpful in stabilizing the patient. [15][16][17] Placement of these devices requires additional time, so any foreknowledge that the patient might need them would be ideal. There are currently no clear advantages in the selection of the type of mechanical cardiac support device, but ongoing studies are looking at this question.…”

Does Right Coronary Artery Stenosis Increase Morbi-Mortality in Patients Undergoing Coronary Artery Bypass Graft for Left Main Coronary Artery Disease?

“…According to current guidelines, surgical revascularization with vascular graft is an absolute indication for patients with unprotected LMCA disease and PCI is an alternative when surgery is not manageable [31] [32]. During induction of anesthesia, and during operation before CPB, decrease in the oxygen supply-demand secondary to suddendrop of coronary blood flow which is not compensated by collateral circulation from RCA (because of RCA stenosis) may cause myocardial infarction [33]. Preoperative prophylactic usage of an IABP is still controversial in patients who have stable hemodynamic parameters but are at high risk [34].…”