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Benke K, Korça E, Boltjes A, Stengl R, Hofmann B, Matin M, Krohe K, Yakobus Y, Michaelsen J, Khizaneishvili L, Szabó G, Veres G. Preventive Impella® Support in High-Risk Patients Undergoing Cardiac Surgery. J Clin Med 2022; 11:jcm11185404. [PMID: 36143050 PMCID: PMC9504963 DOI: 10.3390/jcm11185404] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/05/2022] [Accepted: 09/11/2022] [Indexed: 12/02/2022] Open
Abstract
Background: Patients with severely reduced LV-EF ≤ 30% undergoing CABG have a high risk for postoperative cardiogenic shock. The optimal timing of an adequate hemodynamic support has an impact on short- and midterm mortality after CABG. This study aimed to assess the prophylactic use of the Impella pump in high-risk patients undergoing elective cardiac surgery. Methods: In this single-center retrospective study, 14 patients with LV-EF (≤30%) undergoing cardiac surgery received a prophylactic, perioperative Impella (5.0, 5.5) support between 2020 and 2022. Results: The mean age at surgery was 64.2 ± 2.6 years, the mean preoperative LV-EF was 20.7% ± 1.56%. The duration of Impella support was 4 (3–7.8) days and the 30-day survival rate was 92.85%. Acute renal failure occurred in four patients who were dialyzed on average for 1.2 ± 0.7 days. Mechanical ventilation was needed for 1.75 (0.9–2.7) days. Time to inotrope/vasopressor independence was 2 (0.97–7.25) days with a highest lactate level (24 h postoperatively) of 3.8 ± 0.6 mmol/l. Postoperative LV-EF showed a significant improvement when compared to preoperative LV-EF (29.1% ± 2.6% vs. 20.7% ± 1.56% (p = 0.022)). Conclusion: The prophylactic Impella application seems to be a safe approach to improve the outcomes of this patient population.
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Affiliation(s)
- Kálmán Benke
- Department of Cardiac Surgery, University Hospital Halle (Saale), Martin-Luther University Halle-Wittenberg, 06120 Halle, Germany
- Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary
| | - Edina Korça
- Department of Cardiac Surgery, University Hospital Halle (Saale), Martin-Luther University Halle-Wittenberg, 06120 Halle, Germany
| | - Anniek Boltjes
- Department of Cardiac Surgery, University Hospital Halle (Saale), Martin-Luther University Halle-Wittenberg, 06120 Halle, Germany
| | - Roland Stengl
- Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary
| | - Britt Hofmann
- Department of Cardiac Surgery, University Hospital Halle (Saale), Martin-Luther University Halle-Wittenberg, 06120 Halle, Germany
| | - Meradjoddin Matin
- Department of Cardiac Surgery, University Hospital Halle (Saale), Martin-Luther University Halle-Wittenberg, 06120 Halle, Germany
| | - Katharina Krohe
- Department of Cardiac Surgery, University Hospital Halle (Saale), Martin-Luther University Halle-Wittenberg, 06120 Halle, Germany
| | - Yuliana Yakobus
- Department of Cardiac Surgery, University Hospital Halle (Saale), Martin-Luther University Halle-Wittenberg, 06120 Halle, Germany
| | - Jens Michaelsen
- Department of Cardiac Surgery, University Hospital Halle (Saale), Martin-Luther University Halle-Wittenberg, 06120 Halle, Germany
| | - Levan Khizaneishvili
- Department of Cardiac Surgery, University Hospital Halle (Saale), Martin-Luther University Halle-Wittenberg, 06120 Halle, Germany
| | - Gábor Szabó
- Department of Cardiac Surgery, University Hospital Halle (Saale), Martin-Luther University Halle-Wittenberg, 06120 Halle, Germany
| | - Gábor Veres
- Department of Cardiac Surgery, University Hospital Halle (Saale), Martin-Luther University Halle-Wittenberg, 06120 Halle, Germany
- Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary
- Correspondence: ; Tel.: +49-(0)-345-557-2759; Fax: +49-(0)-345-557-2782
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Upadhyaya VD, Campbell S, Douedi S, Patel I, Asgarian KT, Saybolt MD. Use of Impella CP Device in Off-Pump Coronary Artery Bypass Graft Surgery. Int Heart J 2021; 62:175-177. [PMID: 33455991 DOI: 10.1536/ihj.20-482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Off-pump coronary artery bypass grafting (OPCABG) may be performed on patients with high surgical risk who are poor candidates for traditional mechanical circulatory support. Hemodynamic support with micro-axial mechanical circulatory devices has been performed with limited but promising results.We report a case of a 66-year-old male with multiple comorbidities and low cardiac output undergoing OPCABG. Impella CP device was deployed for "in-pump" support during surgical coronary revascularization resulting in intraoperative stability and uncomplicated post-operative recovery.Previous reports have described the use of the Impella Recover LP 5.0 device for use during OPCABG. We describe the successful and safe perioperative use of the Impella CP device. Despite lower flow rates, adequate support was achieved and the transfemoral cannulation and smaller outer diameter than the Impella 5.0 device may decrease the risk of complications and expedite recovery. Further research will be necessary to determine the optimal perioperative hemodynamic support strategy to offer hemodynamically unstable, high, and prohibitive risk patients.
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Affiliation(s)
- Vandan D Upadhyaya
- Department of Medicine, Hackensack Meridian Jersey Shore University Medical Center
| | - Stuart Campbell
- Department of Surgery, Hackensack Meridian Jersey Shore University Medical Center
| | - Steven Douedi
- Department of Medicine, Hackensack Meridian Jersey Shore University Medical Center
| | - Ishan Patel
- Department of Medicine, Hackensack Meridian Jersey Shore University Medical Center
| | - Kourosh T Asgarian
- Department of Cardiothoracic Surgery, Hackensack Meridian Jersey Shore University Medical Center
| | - Matthew D Saybolt
- Department of Cardiology, Hackensack Meridian Jersey Shore University Medical Center
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Smith NJ, Ramamurthi A, Joyce LD, Durham LA, Kohmoto T, Joyce DL. Temporary mechanical circulatory support prevents the occurrence of a low-output state in high-risk coronary artery bypass grafting: A case series. J Card Surg 2021; 36:864-871. [PMID: 33428241 DOI: 10.1111/jocs.15309] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 11/27/2020] [Accepted: 12/28/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Coronary artery bypass grafting (CABG) is a durable treatment for coronary artery disease. Left ventricular dysfunction (LVD) (a division of cardiothoracic surgery) (ejection fraction < 35%) significantly elevates perioperative risk for patients pursuing surgical revascularization. Periprocedural support with temporary mechanical circulatory support (tMCS) has shown benefit in this patient population. METHODS Four patients with ischemic cardiomyopathy and LVD underwent CABG at our institution between 2017 and 2018. Each patient received perioperative ventricular support using a microaxial tMCS device (Impella 5.0®). The occurrence of a postoperative low-output state (LOS) was assessed for as well as postoperative morbidity and mortality, device-specific complications, and tMCS support duration. RESULTS All patients survived to device explant without device-related complications. Two patients required reoperation for nondevice-related bleeding. All patients were without an LOS at 24 h postoperatively with cardiac indices of 2.9-3.6 L/min/m2 , normalized serum lactate, and vasoactive-inotrope scores of 0-12.0. There was a notably high incidence of acute renal failure (50%), which was observed in patients with preoperative cardiogenic shock. One patient died 10 days after the device explant. Of the three patients that survived to discharge, two were alive at the most recent follow-up. Postoperative device support varied widely (0-500 h). CONCLUSION Perioperative tMCS may be a viable strategy for preventing postoperative LOS in high-risk CABG patients with a low complication rate and acceptable morbidity. The application of microaxial tMCS devices in CABG is an area that warrants further investigation to delineate its impact on perioperative outcomes and potentially expand the indications for such devices.
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Affiliation(s)
- Nathan J Smith
- Department of Surgery, Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Adhitya Ramamurthi
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Lyle D Joyce
- Department of Surgery, Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Lucian A Durham
- Department of Surgery, Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Takushi Kohmoto
- Department of Surgery, Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - David L Joyce
- Department of Surgery, Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Pepino P, Coronella G, Oliviero P, Monaco M, Schiavone V, Finizio F, Biondi-Zoccai G, Frati G, Giordano A. Successful use of the Impella Recover LP 5.0 device for circulatory support during off-pump coronary artery bypass grafting. Int J Surg Case Rep 2014; 5:803-5. [PMID: 25305600 PMCID: PMC4245662 DOI: 10.1016/j.ijscr.2014.07.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Revised: 07/12/2014] [Accepted: 07/13/2014] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Surgical coronary revascularization is being performed with ever increasing frequency in patients at high surgical risk. Off-pump coronary artery bypass grafting (OPCABG) is particularly appealing in such subjects, but may limit the options for concomitant mechanical circulatory support. PRESENTATION OF CASE We hereby report an original case of mechanical circulatory support with the Impella Recover LP 5.0 device during OPCABG in a 61-year-old gentleman with multiple comorbidities and severe left ventricular systolic dysfunction. Specifically, the soft tipped device did not impede surgical manipulation of the heart during the surgical procedure, providing uninterrupted circulatory support to the patient. DISCUSSION This clinical vignette supports the feasibility, safety and efficacy of the Impella Recover LP 5.0 device in patients undergoing OPCABG. CONCLUSION Pending further studies, use of the Impella Recover LP 5.0 device can be envisioned safely for OPCABG.
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Affiliation(s)
- Paolo Pepino
- Unità Operativa di Cardiochirurgia, Presidio Ospedaliero Pineta Grande, Castel Volturno, Italy
| | - Germano Coronella
- Unità Operativa di Cardiochirurgia, Presidio Ospedaliero Pineta Grande, Castel Volturno, Italy
| | - Piermario Oliviero
- Unità Operativa di Cardiochirurgia, Presidio Ospedaliero Pineta Grande, Castel Volturno, Italy
| | - Mario Monaco
- Unità Operativa di Chirurgia Vascolare, Presidio Ospedaliero Pineta Grande, Castel Volturno, Italy
| | - Vincenzo Schiavone
- Unità Operativa di Cardiochirurgia, Presidio Ospedaliero Pineta Grande, Castel Volturno, Italy
| | - Filippo Finizio
- Unità Operativa di Cardiologia, Presidio Ospedaliero Pineta Grande, Castel Volturno, Italy; Unità Operativa di Interventistica Cardiovascolare, Presidio Ospedaliero Pineta Grande, Castel Volturno, Italy
| | - Giuseppe Biondi-Zoccai
- Dipartimento di Scienze e Biotecnologie Medico-Chirurgiche, Sapienza Università di Roma, Latina, Italy
| | - Giacomo Frati
- Dipartimento di Scienze e Biotecnologie Medico-Chirurgiche, Sapienza Università di Roma, Latina, Italy
| | - Arturo Giordano
- Unità Operativa di Interventistica Cardiovascolare, Presidio Ospedaliero Pineta Grande, Castel Volturno, Italy.
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