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Intraoperative balloon-catheter dilatation: University of Florida experience
Insights
Intraoperative coronary balloon-catheter dilatation safely treats stable angina with good early results. While some narrowings worsened, the procedure offers potential for more complete myocardial revascularization.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Stable angina significantly impacts patient quality of life.
- Coronary artery bypass surgery is a standard treatment for severe coronary artery disease.
- Minimally invasive techniques are continually explored to improve surgical outcomes.
Purpose of the Study:
- To evaluate the safety and efficacy of intraoperative coronary artery balloon-catheter dilatation as an adjunct to coronary artery bypass surgery.
- To assess the impact of this adjunctive procedure on angina relief and coronary artery patency.
Main Methods:
- Thirty-four patients with stable angina underwent coronary artery bypass surgery.
- Intraoperative coronary artery balloon-catheter dilatation was performed on 35 vessels at 50 sites.
- Early and late postoperative angiographic studies were conducted to assess vessel status.
Main Results:
- 100% early relief of angina was achieved, with one operative death.
- Early angiography showed improvement in 32% of treated narrowings, with discrete narrowings benefiting more than diffuse ones.
- Late follow-up revealed mixed results, with some narrowings worsening, but the procedure was deemed safe with acceptable clinical outcomes.
Conclusions:
- Adjunctive intraoperative coronary balloon-catheter dilatation can be performed safely.
- The procedure demonstrates acceptable clinical results and may facilitate more complete myocardial revascularization.
- Further research may explore optimizing patient selection and technique for improved long-term patency.
Abstract:
Thirty-four patients with stable angina underwent coronary artery bypass surgery with supplemental intraoperative coronary artery balloon-catheter dilatation. Coronary dilatation was performed on 35 vessels at 50 sites. The balloon catheter could not be passed through one stenotic site. Intimal dissection occurred at two sites, as noted on early postoperative angiographic studies, with resolution on follow-up studies. There was one perioperative myocardial infarction, 100% early relief of angina, and one operative death. Of 25 distal arterial narrowings studied early by angiography (mean, 10 days), 15 (60%) were unchanged, two (8%) were worse, and eight (32%) were improved. Discrete narrowings improved more than diffuse narrowings; in 46% of the former there was an increase in luminal diameter, in comparison to only 17% of the latter. During a maximal 34-month follow-up period, two patients developed recurrent angina and one died of congestive heart failure. Of 13 distal coronary narrowings studied late (mean, 1 year), six (46%) were unchanged, three (23%) were worse, and four (31%) were improved. Postoperative serial catheterization (early and late) of 10 distal narrowings revealed that nine were unchanged and one was worse. Adjunctive intraoperative coronary balloon-catheter dilatation can be performed safely with acceptable clinical results. The procedure may also allow more complete revascularization of the myocardium.