Intraoperative Balloon Research Articles

Abstract 15115: Including Intra- and Post-operative Factors in Delirium Predictive Rule After Coronary Artery Bypass Graft Could Increase Its Accuracy

Objectives: Postoperative Delirium (POD) frequently occurs after coronary artery bypass graft (CABG). Patients screened with an appropriate POD predictive rule (PR) may benefit from targeted preventive treatment. The accuracy of current available PRs, however, remained modest with the C statistic below 0.75, partially because none of which include intra- and post-operative (IPOP) as well as preoperative (preop) risk factors at the same time. Since POD is a postoperative (postop) phenomenon, IPOP factors might play important roles. This study aimed to develop and validate a PR based on perioperative (periop) factors to predict POD after CABG. Methods: This prospective study included two cohorts (derivation [n = 132] and validation [n = 53]) of patients who underwent first isolated CABG. POD was assessed using the Confusion Assessment Method for Intensive Care Unit twice daily until 5 days after operation. Logistic regression and a bootstrap resampling procedure were used for model development and internal validation. Rule performance was measured with the C statistic. Points were assigned to each variable and a simplified rule was derivated to identify subjects at low, moderate, and high risk of POD based on their total risk score. The proportion of subjects with POD in each risk group was calculated. Results: The PR included 5 periop factors: age (≥68y), female, intraoperative intra-aortic balloon pump use, postop atrial fibrillation and serum IL-6 ≥ 478 pg/ml at 18th hour. The relative risk of POD in moderate (2~5 points) and high risk group (6~8 points) were 6.7 and 10.9 folds higher compared with low risk group (0~1 point), respectively (Fig A). The model C statistic was 0.861 (Fig B) in the derivation cohort, 0.829 in internal validation, and 0.754 in validation cohort. Conclusion: We developed a POD PR for patients undergoing CABG, which includes IPOP risk factors as well as preop risk factors. The new developed rule demonstrated more powerful in predicting POD after CABG.

Intraoperative balloon angioplasty using fogarty artertial embolectomy balloon catheter for creation of arteriovenous fistula for hemodialysis: single center experience.

BackgroundThe purpose of this study was to evaluate the use of a Fogarty arterial embolectomy catheter (Fogarty catheter) in intraoperative balloon angioplasty of the cephalic vein, in order to determine its effect on the patency of arteriovenous fistulas (AVFs) created for hemodialysis access.MethodsA total of 156 patients who underwent creation of an AVF were divided into two groups, based whether a Fogarty catheter was used during AVF creation. Group A (89 patients) comprised the patients who underwent balloon angioplasty with a Fogarty catheter during the operation. Group B (67 patients) included the patients in whom a Fogarty catheter was not used during the operation. Patient records were reviewed retrospectively and documented. The patency rate was determined by the Kaplan-Meier method.ResultsThe records of 156 patients who underwent the creation of an AVF from January 2007 to October 2011 were included. The mean follow-up duration was 40.2±19.4 months (range, 1 to 97 months). The patency rates in group A at 12, 36, and 72 months were 83.9%±3.9%, 78.3%±4.6%, and 76.3%±4.9%, respectively, while the corresponding patency rates in group B were 92.5%±3.2%, 82.8%±0.5%, and 79.9%±5.7%, respectively. The patency rates in group B were found to be slightly higher than those in group A, but the difference was not statistically significant (p=0.356).ConclusionIntraoperative balloon angioplasty of the cephalic vein using the Fogarty catheter is a simple and easily reproducible procedure, and it can be helpful in increasing AVF patency in cases of insufficient runoff or a suboptimal cephalic vein.

BALLOON POST-DILATION OUTCOMES FOLLOWING TRANSCATHETER AORTIC VALVE REPLACEMENT AT A SINGLE COMMUNITY CARDIOVASCULAR CENTER

Paravalvular leak is a significant clinical predictor of mortality after transcatheter aortic valve replacement (TAVR). Intra-operative balloon post-dilation remains the most commonly used method to reduce paravalvular leak. However, no studies have compared outcomes of those patients who required

4:42 PM; Abstract No. 144 - Internal iliac artery balloon occlusion placement for management of placenta accreta: a retrospective study

Inflation of occlusion balloons in the internal iliac arteries can be performed in women with abnormal placental implantation at high risk of hemorrhage during surgery in the hopes of decreasing morbidity and mortality. However, due to the limited literature, this remains a controversial technique. The primary objective of our study is to review the outcomes of such cases at our institution. A search was performed to retrospectively identify all patients with abnormal placental implantation and pre-operative balloons placed between January 1st 2006 and June 30th 2013 at our institution. Data extracted included demographics, hemoglobin levels, blood transfusions, pathology and need for hysterectomy. 17 patients fulfilled the criteria, representing one of the largest samples ever published of this type of study. The indication for pre-operative balloon placement was placenta accreta in 11 patients, placenta increta in 1 patient and placenta percreta in 5 patients. Intra-operative balloon inflation was performed in 11 (65%) patients: 6 (65%) with placenta accreta, 1 (100%) with placenta increta (100%), and 4 (80%) with placenta percreta. The estimated operative blood loss for patients in whom the balloons were inflated was 750-4000mL (average 1450mL) versus 800-3000mL (average 1825mL) in patients in whom the balloons were not inflated (p=0.65). The average drop in hemoglobin between the group with and without inflation of balloon was 22Hgb/L and 31Hgb/L, respectively (p=0.21). Despite a trend toward decrease blood loss in patients with balloon inflation our data fails to demonstrated a statistically significant difference. While the data may seem to indicate the lack of usefulness of this technique, since the balloons are only inflated during surgery if bleeding is deemed excessive, both groups are not easily comparable. Assuming the surgeon’s impression of increased bleeding was correct, then balloon inflation may have been the only reason that this group of patients did not lose on average more blood than the other group. Carefully designed prospective studies will likely be needed to prove the usefulness of this technique.

Stented bovine jugular vein graft (Melody valve) for surgical mitral valve replacement in infants and children

The options for mitral valve replacement in children with irreparable mitral valve disease have been limited to fixed-diameter prostheses that do not accommodate for somatic growth. We have modified an externally stented bovine jugular vein graft (Melody valve) for implantation in this cohort. Because it is not a fixed-diameter prosthesis, we hypothesized that the valve can be expanded in the catheterization laboratory as the child grows. The medical records of patients who had undergone Melody valve implantation in the mitral or left atrioventricular valve position from 2010 to 2013 were reviewed. Eleven patients had undergone Melody valve implantation at a median age of 7 months (range, 2-28). The techniques of valve modification and implantation included stent shortening, adding a pericardial sewing cuff, intraoperative balloon expansion, and fixation of the distal stent to the inferior left ventricle wall. The valve was competent, with a low gradient acutely postoperatively in all patients. One patient died, and one required permanent pacemaker implantation. One patient developed valve dysfunction and required explantation. Two patients without a pericardial sewing cuff developed paravalvular leaks. One patient who had not undergone distal stent fixation developed left ventricular outflow tract obstruction. Three patients who had undergone subsequent catheter-based balloon expansion of the valve have continued to demonstrate acceptable valvular function. The Melody valve has demonstrated acceptable short-term function. Implantation techniques to prevent left ventricular outflow tract obstruction (suture fixation of the distal stent) and paravalvular leaks (theaddition of a pericardial cuff) should be considered. The Melody valve can be percutaneously expanded as the child grows.

Tu1060 Precise Liver Resection by Intraoperative Intervention Intravascular Segmental Vessel Balloon Catheter Occlusion

Tu1060 Precise Liver Resection by Intraoperative Intervention Intravascular Segmental Vessel Balloon Catheter Occlusion

Valve-Sparing Options in Tetralogy of Fallot Surgery

Given late outcomes of patients with tetralogy of Fallot repaired in the 1970s and 1980s, as well as a better understanding of the late deleterious effects of pulmonary regurgitation, there is a tendency toward preservation of the pulmonary valve function during primary repair of tetralogy of Fallot. The bar keeps moving downward, to include smaller and more dysmorphic pulmonary valves. This article reviews some useful indications and techniques for valve-sparing options, including intraoperative balloon dilation and cusp reconstruction using a patch. Just like other valve repair techniques, no one technique can be applied uniformly, and surgeons must master a wide armamentarium of techniques.

Exchange of intraoperative balloon occlusion of the internal iliac artery for the common iliac artery during cesarean hysterectomy in a patient with placenta percreta

Patient: Female, 36Final Diagnosis: Pregnancy – placenta incretaSymptoms: —Medication: —Clinical Procedure: Cesarean hysterectomySpecialty: Obstetrics and GynecologyObjective:Unusual clinical courseBackground:The generally accepted treatment for placenta percreta is cesarean hysterectomy without attempts to detach the placenta. Preoperative internal iliac artery balloon occlusion (IIABO) has been widely performed to minimize blood loss during cesarean hysterectomy for an abnormal attachment of the placenta. Our case is the first reported case of common iliac artery balloon occlusion (CIABO) being more effective than IIABO for reducing blood loss during a cesarean hysterectomy in the same patient.Case Report:We performed cesarean hysterectomy with IIABO in a 36-year-old Japanese female who had placenta percreta. However, there was still a large amount of blood loss. We immediately changed the balloon from the internal iliac artery to the common iliac artery, which visibly reduced the amount of blood loss. We finally achieved cesarean hysterectomy.Conclusions:CIABO was found to be more effective than IIABO for reducing blood loss during cesarean hysterectomy. Failure of IIABO can be explained by the presence of extensive anastomoses in the pelvic vasculature.

IABP before cardiac surgery: clinical benefit compared to intraoperative implantation

The aim of this study was to determine whether preoperative compared to intraoperative intra-aortic balloon counterpulsation (IABP) is advantageous regarding 30-day and 2-year survival in high-risk patients (acute myocardial infarction, severely impaired left ventricular ejection fraction (LVEF), low output syndrome) undergoing coronary surgery. In the years 2004 to 2008, 156 consecutive patients undergoing coronary surgery with IABP support (119 preoperative, 37 intraoperative IABP) were observed. Applying Fisher's exact test, as well as Wilcoxon and median tests, possible group differences were evaluated. After univariate analysis, models of logistic regression and Cox-regression were built. Preoperative hemodynamic state and risk profile of the two patient groups were comparable: patients with preoperative IABP showed a similar level of urgency (21.9% vs. 18.9% emergencies), cardiogenic shock (8.4% vs. 10.8%), inotropes (8.4% vs. 8.1%), impaired LVEF (30.3% vs. 29.7%) and ventilation (5.9% vs. 5.4%) compared to patients with intraoperative IABP. Nevertheless, patients with intraoperative IABP demonstrated a significantly higher 30-day mortality rate (37.8% vs. 5.9%) and 2-year mortality rate (54.0% vs. 18.1%) compared to patients with preoperative IABP. Logistic regression revealed that patients with intraoperative IABP have a 16-times higher 30-day mortality rate after coronary surgery (OR: 16.386, 95% CI: 4.858-55.266) than patients with preoperative IABP. Two-year mortality (OR: 9.317, 95% CI: 3.430 to 25.311) and survival time were significantly better in patients with preoperative IABP therapy. Considering the significant benefit for patients with preoperative compared to intraoperative IABP and the absence of vascular problems after IABP insertion, the results of this study indicate a more liberal indication for IABP in high-risk patients before coronary bypass surgery.

The balloon dilation of the pulmonary valve during early repair of tetralogy of Fallot

Progressive pulmonary valve (PV) regurgitation leads to right ventricular failure after repair of tetralogy of Fallot (TOF). We sought to evaluate our results with the preservation of the PV in selected patients with TOF. All patients with TOF who were scheduled for PV's preservation between June 2007 and May 2010 were enrolled. Surgical correction involved the combination of early transatrial repair and intraoperative balloon dilation of the PV annulus. Of 18 patients, 16 (89%) underwent a successful preservation of the PV. Median age at surgery was 3.1 months (range 2.4-4.7 months). Median preoperative PV Z-score was -2.5 (range -1.4 to -3.12) and the median peak right ventricle outflow tract (RVOT) gradient was 80 mm Hg (range 49-90 mm Hg). No procedure-related complications were reported. The size of the PV annulus after the balloon dilation was appropriate for body surface area in all patients. Median follow-up time was 1.4 years (range 0.5-3.3 years). Reoperation was needed in one patient 3 months after repair because of residual subvalvar RVOT obstruction. The remaining 15 patients are alive and well. The median PV Z-score is 0 (range -0.2 to 1). Median peak RVOT gradient is 20 mm Hg (range 12-32 mm Hg). The PV is competent in seven patients; mild PV regurgitation is present in seven patients and moderate in one. The integrity of the PV annulus and PV function can be preserved in selected patients during early repair of TOF when using concomitant balloon dilation. The PV preservation will hopefully prevent long-standing RV dysfunction.

Predictive Factors for Intraoperative Balloon Dilation in Semirigid Ureteroscopic Lithotripsy

To analyze preoperative predictive factors for intraoperative balloon dilation in semirigid ureteroscopic lithotripsy. We retrospectively reviewed data from 397 consecutive semirigid ureteroscopic lithotripsies performed in 389 patients with ureteral stones at our institution during the calendar year 2010. Preoperative patient-related variables (age, sex, body mass index, history of urinary tract infection, previous stent placement, and time from initial presentation to intervention) and stone-related variables (laterality, numbers, location, width, and degree of hydronephrosis) were collected. Univariate analysis and multivariate logistic regression were performed to examine the statistical association between these variables and the use of intraoperative balloon ureteral dilation. Intraoperative balloon dilation was performed in 109 (27.5%) procedures. Univariate analysis identified increasing stone width (P<0.001) and lack of previous stent placement (P<0.001) as preoperative predictors of intraoperative balloon dilation. Stone width (P<0.001, odds ratio [OR] 1.274, 95% confidence interval [CI] 1.147-1.415) and lack of previous stent placement (P<0.001, OR 0.025, CI 0.006-0.105) remained independently associated with intraoperative balloon dilation in multivariate logistic regression. To our knowledge, our study is the first to statistically analyze the potential predictive factors for intraoperative balloon dilation in semirigid ureteroscopic lithotripsy. Larger stone width was significantly associated with intraoperative balloon dilation, whereas the presence of an indwelling ureteral stent, for at least 1 week, nearly eliminated the need for balloon dilation in subsequent ureteroscopic lithotripsy.

Valve-Sparing Options in Tetralogy of Fallot Surgery

Given late outcomes of patients with tetralogy of Fallot repaired in the 1970s and 1980s, as well as a better understanding of the late deleterious effects of pulmonary regurgitation, there is a tendency toward preservation of the pulmonary valve function during primary repair of tetralogy of Fallot. The bar keeps moving downward, to include smaller and more dysmorphic pulmonary valves. This article reviews some useful indications and techniques for valve-sparing options, including intraoperative balloon dilation and cusp reconstruction using a patch. Just like other valve repair techniques, no one technique can be applied uniformly, and surgeons must master a wide armamentarium of techniques.

The evolving role of intraoperative balloon pulmonary valvuloplasty in valve-sparing repair of tetralogy of Fallot

The evolving role of intraoperative balloon pulmonary valvuloplasty in valve-sparing repair of tetralogy of Fallot

The evolving role of intraoperative balloon pulmonary valvuloplasty in valve-sparing repair of tetralogy of Fallot

The late morbidity of pulmonary regurgitation has intensified the interest in valve-sparing repair of tetralogy of Fallot. This study reviewed a single institution's experience with valve-sparing repair and investigated the role of intraoperative balloon valvuloplasty. A retrospective chart review identified 238 patients who underwent complete primary repair of tetralogy of Fallot at less than 180 days of age. Patients were divided into 4 groups on the basis of the type of right ventricular outflow tract repair: transannular patch (n=111), commissurotomy or standard rigid dilation (n=71), intraoperative balloon pulmonary valvuloplasty (n=32), or no valvar intervention (n=24). Baseline demographic and anatomic factors differed among the 4 procedural groups with substantial overlap. Among 142 patients with pulmonary valve hypoplasia (z score, -2 to -4), 37% had valve-sparing repair. These patients had significant annular growth over time: z score increased 0.67 and 1.00 per year in the intraoperative balloon valvuloplasty (P<.001) and traditional valve-sparing (P<.001) groups, respectively. Rates of valve growth did not differ across groups, but z scores were 0.58 lower for the balloon valvuloplasty group across all time points (P=.001). Freedom from reintervention and surgery was shorter for the balloon valvuloplasty group than for the other groups (P<.001). Patients with tetralogy of Fallot and pulmonary valve hypoplasia who undergo valve-sparing repair with intraoperative balloon valvuloplasty have significant longitudinal annular growth, with normalization of annular size over time. Despite application in patients with more hypoplastic valves, balloon valvuloplasty resulted in similar valve growth and pulmonary regurgitation as traditional methods, but higher rates of reintervention. Although the precise role of this technique needs further refinement, it is likely to be most useful in patients with moderate pulmonary stenosis and moderate pulmonary valve dysplasia.

Intermittent Obstruction Resulting from Multiple Intestinal Webs

Intestinal webs are a rare cause of bowel obstruction. A case of a 32-year-old man with multiple intestinal webs causing intermittent, partial bowel obstruction is described. The webs were initially detected with capsule endoscopy. The patient was treated with intraoperative endoscopy and balloon dilation. At early follow-up, no recurrence of his symptoms was evident.

体外循環補助下根治的腎摘出術後に脊髄梗塞をきたした下大静脈及び右心房内腫瘍塞栓を伴う腎細胞癌の１例

A 51 year-old man admitted to our hospital for macroscopic hematuria and right abdominal mass. CT demonstrated a large hypervascular mass and tumor thrombus in the inferior vena cava and right atrium. We diagnosed right renal cancer (stage III), and he underwent radical nephrectomy and resection of tumor thrombus with extracorporeal circulation. Operative time was 9 hours. Time for extracorporeal circulation was 119 minutes, and it took 60 minutes for intraoperative balloon occlusion of descending aorta in order to arrest hemorrhage. Pathological diagnosis was clear cell carcinoma of the kidney (pT3c, N0, M0). Four days after surgery, paraplegia was evident, and a diagnosis of spinal cord infarction was made based on neurologic examination and MRI findings. In cases with such a surgery requiring extracorporeal circulation, preoperative meeting with cardiologists and anesthetists is indispensable in order to fully understand the possible complications. Especially, to keep a careful watch and prepare for spinal cord ischemia is mandatory.

Vascular Ultrasound Imaging of Axillary Artery Thrombosis in a Neonate

This case report presents a 4-day-old neonate with axillary artery thrombosis born to a diabetic mother. After receiving an angiogram and blood workup, the neonate then received an ultrasound. The angiogram, as well as the ultrasound, revealed left axillary artery thrombus. The neonate received low molecular weight heparin treatment and was closely monitored over the course of the hospitalization. Because of the rarity of neonatal axillary arterial thrombosis, the condition is sporadically reported in literature. Causes of this condition have been attributed to sepsis, congestive heart failure, trauma, coagulation disorders, polycythemia, and dehydration. It is documented that a clot can form in the renal vein, inferior vena cava, ductus arteriosus, or umbilical vessels and travel to an upper extremity artery. Treatments include clinical observation, systemic anticoagulation, surgical thrombectomy, or intraoperative balloon angioplasty. This case demonstrates the ability of ultrasound to diagnose and follow upper extremity arterial thrombus in neonates.

Intraoperative Balloon Angioplasty in Diabetic Foot with Peripheral Artery Occlusive Disease During Amputation - Two Case Reports -

Amputation should be considered for the patients with limb necrosis or infection due to major vessel obstruction combined with diabetes. Patients with peripheral artery occlusive disease combined with diabetes have a higher risk of amputation and a higher possibility of reoperation than those patients without diabetes because of complications that include hematoma, infection and necrosis of the stump. We report here on 2 cases for which balloon angioplasty was used to promote wound healing on the stump site during amputation, and the patients had peripheral artery occlusive disease with a diabetic foot. The wounds healed early without complication in both cases.

303: Intraoperative bilateral common iliac arteries balloon occlusion during cesarean section in placental adhesive disorders: A case-control study

303: Intraoperative bilateral common iliac arteries balloon occlusion during cesarean section in placental adhesive disorders: A case-control study

Combined treatment with temporary intraoperative balloon occlusion of common iliac arteries and hysteroscopic endocervical resection with postoperative cervical balloon for intractable cervical pregnancy in an infertile woman

To describe treatment of an intractable cervical pregnancy that failed intracervical Foley catheter tamponade and uterine artery embolization followed by curettage of gestational tissue. Case report. Tertiary-care university hospital. A 37-year-old infertile woman who achieved an 8-week cervical pregnancy after IVF-ET. Temporary intraoperative balloon occlusion of bilateral common iliac arteries in combination with hysteroscopic endocervical resection of the gestational tissue, followed by postoperative intracervical balloon compression for 3 days. Serial serum beta-hCG concentrations. Complete removal of gestational products with preservation of fertility. Temporary balloon occlusion of bilateral common iliac arteries in combination with hysteroscopic endocervical resection of cervical pregnancy was effective in the treatment of intractable cervical pregnancy and preserved the woman's future fertility.