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

Upadhyaya, Vandan; Campbell, Stuart; Douedi, Steven; Patel, Ishan; Asgarian, Kourosh T.; Saybolt, Matthew D.

doi:10.1536/ihj.20-482

Cited by 5 publications

(2 citation statements)

References 14 publications

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“…Several reports indicate that the Impella 5.0 may assist CABG [3,4], but there is only one report on the Impella CP in off-pump CABG [5]. Our case shows that in cardiogenic shock during MI, the Impella CP can support the entire treatment, i.e.…”

mentioning

confidence: 62%

Impella CP in cardiogenic shock due to acute myocardial infarction: From primary angioplasty to LIMA-LAD grafting

et al. 2021

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mentioning

confidence: 62%

Impella CP in cardiogenic shock due to acute myocardial infarction: From primary angioplasty to LIMA-LAD grafting

et al. 2021

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“…5–7), we did the surgery under cardiopulmonary support and without aortic cross-clamping. Although ‘off-pump’ coronary artery bypass grafting only with Impella support may also be possible [ 21 ], Impella support insufficiency due to dislocation of the Impella may frequently occur when the heart is lifted during the operation, so we prefer to do it under cardiopulmonary bypass support.…”

Section: Discussionmentioning

confidence: 99%

Impella support as a bridge to heart surgery in patients with cardiogenic shock

Saito

Shibasaki

Matsuoka

et al. 2022

Interactive CardioVascular and Thoracic Surgery

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OBJECTIVES In patients with cardiogenic shock, delayed surgery after stabilization of haemodynamics and improvement in end-organ function by mechanical circulatory support is known to yield better outcomes than emergency surgery. We aimed to investigate the effectiveness of Impella (Abiomed, Danvers, MA, USA) as a bridge to cardiac surgery in patients with cardiogenic shock. METHODS We reviewed 7 patients with cardiogenic shock who underwent Impella support as a bridge to cardiac surgery using cardiopulmonary bypass at our institution between April 2018 and August 2021. RESULTS Cardiogenic shock was caused by ventricular septal rupture in 3 patients, papillary muscle rupture in 1 and acute myocardial infarction in 3. Cardiac surgery was delayed by 1–7 (3.9 ± 2.5) days with Impella support after the diagnosis of cardiogenic shock, during which the hepatic and renal function of the patients improved significantly. Device-related or operation-related adverse events included re-exploration for bleeding in 3 patients, acute limb ischaemia due to thromboembolism in 1 and intraoperative aortic dissection in 1. Thirty-day mortality was 14.3%, and the cumulative survival was 71.4% at 1 year. The survival tended to be better than that in historical control group in which extracorporeal membrane oxygenation was used as a bridge to surgery (P = 0.0992). CONCLUSIONS Impella is an effective tool for bridging patients with cardiogenic shock to surgery. This strategy may improve surgical outcomes in patients with cardiogenic shock. However, prolonged Impella support may increase significant adverse events, and further investigation is required to determine the optimal duration of support before surgery.

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