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Micropumps to support the heart during CABG
B Meyns1, P Sergeant, T Nishida
1Department of Cardiac Surgery, Gasthuisberg University Hospital, Herestraat 49, KULeuven, 3000, Leuven, Belgium. burt.meyns@un.kuleuven
Insights
Micropump support significantly improved hemodynamic performance and myocardial blood flow during beating heart coronary artery bypass grafting (CABG) surgery for triple vessel disease in sheep.
Area of Science:
- Cardiovascular Surgery
- Medical Devices
- Hemodynamics
Background:
- Beating heart coronary artery bypass grafting (CABG) for complex triple vessel disease presents challenges.
- Myocardial ischemia during surgical manipulation can lead to adverse outcomes.
Purpose of the Study:
- To evaluate the efficacy of biventricular micropump support during beating heart CABG.
- To assess the impact of micropumps on myocardial protection and hemodynamic stability.
Main Methods:
- 12 sheep underwent sequential occlusion of three coronary arteries.
- Animals were divided into control and biventricular micropump support groups.
- Hemodynamics and myocardial flow were assessed during occlusion and reperfusion.
Main Results:
- Micropump-supported animals showed significantly better hemodynamic performance and myocardial contractility post-procedure.
- Subendocardial blood flow was markedly improved in all left ventricular regions in the supported group.
- Survival rates were higher in the micropump-supported group compared to controls.
Conclusions:
- Biventricular micropump support enhances myocardial resistance to ischemia during beating heart CABG.
- This technology can improve the safety and applicability of CABG for complex triple vessel disease.
Objective:
To show the effect of myocardial support by micropumps during beating heart CABG for triple vessel disease.
Methods:
In 12 sheep, three coronary arteries (LAD, intermediate branch and circumflex) were consecutively occluded for 10 min. The animals were divided in two groups: group 1 without support (n=6) and group 2 with biventricular support of intravascular micropumps. The pumps (diameter 6.4 mm) were placed through peripheral access (femoral artery and jugular vein) and advanced under fluoroscopic guidance. The hemodynamic evolution was analyzed during the procedure and 2 h of reperfusion. Myocardial flow was assessed by colored microspheres. Differences between groups were analyzed by ANOVA for repeated measurements and post-hoc testing in case of significance.
Results:
All of the pump-supported animals survived the procedure, 1 of the control animals died of resistant ventricular fibrillation. At the end of the reperfusion period, the hemodynamic performance and myocardial contractility was significantly better in the pump-supported group (cardiac output: 2.4+/-0.9 vs. 3.3+/-0.9 l/min, P=0.0192; mean arterial blood pressure: 51+/-23 vs. 73+/-9 mmHg, P=0. 036; first derivative of the left ventricular pressure: 561+/-271 vs. 947+/-316 mmHg/s, P=0.0074). After the procedure, subendocardial blood flow was significantly better in all areas of the left ventricle in group 2 (0.935+/-0.427 ml/min per g vs. 0.409+/-0.183 ml/min per g in group 1; P=0.0366).
Conclusion:
The supported heart is more resistant to repetitive local ischemia. Support by microaxial pumps can make beating heart surgery safer and applicable for more complex cases.