Abstract
Selection of the ideal surgical procedure for coronary revascularization in patients with severe cardiac dysfunction at times may represent a challenge. In recent years, with the advent of surgical large microaxial pumps, e.g., Impella 5.0 (Abiomed Inc., Boston, USA), specific support and effective unloading of the left ventricle has become available. In the interventional field, good results have been achieved with smaller microaxial pumps in the setting of so-called protected percutaneous coronary intervention. In this study, we would like to share our early experience with surgical coronary revascularization under the sole support of Impella 5.0, omitting the use of heart–lung machine in three cases of severe cardiac dysfunction due to complex ischemic heart disease. Effective circulatory support intraoperatively and postoperatively speaks in favor of this technique in selected patients.
Highlights
Growing evidence supports coronary artery bypass grafting (CABG) for ischemic heart disease (IHD) in front of severe cardiac dysfunction [1]
We demonstrate the feasibility of this approach by sharing our experience in three successful cases in which Impella 5.0 was inserted preoperatively to stabilize hemodynamics during the surgery and after surgical coronary revascularization without cardiopulmonary bypass (CPB)
Further operation is performed after median sternotomy and under Impella 5.0 support. (Fig. 1c) Revascularization order follows the principles of Off-pump CABG (OPCAB) procedure, starting with revascularization of the left anterior descending coronary artery (LAD), continuing with left circumflex coronary artery (LCX) territory and addressing the right coronary artery (RCA)
Summary
Growing evidence supports coronary artery bypass grafting (CABG) for ischemic heart disease (IHD) in front of severe cardiac dysfunction [1]. Off-pump CABG (OPCAB) has been advocated for the advantage of omission of cardiopulmonary bypass (CPB), which by itself is known to trigger perioperative complications, e.g., systemic inflammatory response syndrome and perioperative stroke. OPCAB may provide certain advantage over standard CABG because of a lack of cardioplegic arrest and associated myocardial ischemia, potentially aggravating perioperative myocardial damage [2,3,4]. We report on a surgical method of CABG supported by Impella 5.0 (Abiomed Inc., Boston, USA) and without the use of the heart–lung machine, in the following termed Impella supported coronary artery bypass, ISCAB. We demonstrate the feasibility of this approach by sharing our experience in three successful cases in which Impella 5.0 was inserted preoperatively to stabilize hemodynamics during the surgery and after surgical coronary revascularization without CPB
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