First Turkish Experiences of Assisted Beating-Heart Coronary Artery Bypass Graft with the Impella Microaxial Ventricular Assist Device�

Abstract

The importance of minimally invasive cardiac operations, performed off-pump, without the support of cardiopulmonary bypass (CPB), is continuously increasing. Complete revascularization of obstructed coronary arteries is needed to obtain a better long-term outcome. Insertion into the left ventricle of an efficient microaxial pump can be useful when targeting an important coronary artery located at posterior wall of the heart in a patient with hemodynamic deficiency. The use of such a device can enable surgeons to avoid conversion from a preplanned off-pump strategy to traditional on-pump coronary bypass surgery. The Impella Microaxial Ventricular Assist Device (VAD) (Abiomed, Aachen, Germany) is a miniature pump with a 7-mm catheter and a flow rate of approximately 2.5-5 L/min. This device can enable cardiovascular surgery to be performed without damaging the left ventricle and causing serious aortic deficiency. Therefore, in patients with serious comorbidity, complete revascularization may be performed off pump, with the heart beating, because of the hemodynamic stability provided with the support of the microaxial intracardiac pump. If required, this pump can also support the heart during the early postoperative period. We report the first assisted beating-heart coronary artery bypass graft surgery performed with the Impella Microaxial VAD in our country. The surgery was performed on 2 patients considered high risk on the basis of EUROSCORE testing.

Successful use of the Impella Recover LP 5.0 device for circulatory support during off-pump coronary artery bypass grafting

“…Accordingly, use of the Impella device in this specific setting could be particularly appealing. 4,5 This device provides substantial circulatory support up to 5.0 L/min while requiring only the vascular insertion of a 21 French sheath. Despite its remarkable hemodynamic performance and suitability for short as well as mid-term usage, there has been so far no extensive experience with use of the Impella device in patients undergoing OPCABG.…”

“…Despite its remarkable hemodynamic performance and suitability for short as well as mid-term usage, there has been so far no extensive experience with use of the Impella device in patients undergoing OPCABG. Given our favorable experience to date with the Impella device for percutaneous coronary intervention and the fact that the device ends with a soft-tipped section, and two anedoctal reports from the literature, 4,5 we hypothesized that it could be used safely and effectively even for OPCABG. The case hereby reported supports this hypothesis and warrants further exploration of the role and larger series of Impella use in the setting of OPCABG.…”

“… 2,3 Accordingly, only minimal experience has been accrued so far on this indication for the Impella device. 4,5 …”

Use of Impella CP Device in Off-pump Coronary Artery Bypass Graft Surgery

“…Currently Impella device (Abiomed, Danvers, MA, USA) considers manipulations of the heart that would be used during cardiothoracic surgery to be a contraindication to the use of the device [7,8]. Despite the concern, select cases have been describing the use of Impella Recover LP 5.0 during OPCABG [9,10]. Impella 5.0 delivers upwards of 5.0 L/min support at the consequence of a 21 French inner diameter sheath through a surgically cannulated axillary arteriotomy.…”

Use of Impella CP Device in Off-Pump Coronary Artery Bypass Graft Surgery

“…8,9) Despite the concern, select cases have been describing the use of Impella Recover LP 5.0 during OPCABG. 10,11) Impella 5.0 delivers maximum rate of 5.0 L/minute support at the consequence of a 21 French inner diameter sheath through a surgically cannulated axillary arteriotomy.…”