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Circulatory support for OPCAB procedures
Xavier M Mueller1, Ludwig K von Segesser
1Clinic for Cardiovascular Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. xavier.mueller@chuv.hospvd.ch
Insights
Mini-pump circulatory support was developed for off-pump coronary artery bypass grafting (OPCAB) to manage hemodynamic instability. While OPCAB is now often performed without support, miniaturized pumps offer new options for acute heart failure.
Area of Science:
- Cardiovascular Surgery
- Medical Device Development
- Hemodynamics
Background:
- Off-pump coronary artery bypass grafting (OPCAB) can cause hemodynamic disturbances due to heart verticalization.
- Miniature circulatory support pumps were initially developed to address right heart strain during OPCAB.
Purpose of the Study:
- To review existing mini-pump technologies for cardiac support.
- To introduce a novel integrated cardiopulmonary bypass (CPB) circuit concept.
- To explore new indications for miniaturized circulatory support devices.
Main Methods:
- Review of three types of mini-pumps (two right-sided, one biventricular).
- Discussion of an integrated cardiopulmonary bypass (CPB) circuit with reduced surface area and priming volume.
- Analysis of the potential for peripheral access insertion of these devices.
Main Results:
- OPCAB can often be performed without circulatory support due to improved surgical techniques.
- Miniaturized pumps, initially for OPCAB, show promise for short-term support in acute heart failure.
- Peripheral access offers less invasive options compared to existing devices.
Conclusions:
- Miniaturized circulatory support devices, though initially for OPCAB, have evolved.
- These devices present a less invasive alternative for acute heart failure management.
- The development of smaller, peripherally inserted pumps addresses limitations of current invasive technologies.
Abstract:
During off-pump coronary artery bypass grafting (OPCAB) which allows complete revascularization through a median sternotomy, revascularization of the lateral and posterior walls requires the verticalization of the heart, which may cause haemodynamic disturbance. This concern has stimulated the development of circulatory support with mini-pumps. Initially, these pumps were designed for the right side of the heart, which was found to be the main contributor to haemodynamic instability under experimental conditions. The three types of mini-pumps that have been developed so far - two for the right side of the heart and one for both sides - are reviewed as well as a new concept of integrated cardiopulmonary bypass (CPB) circuit with reduced surface and priming volume. However, with increasing experience and improved methods of exposition, OPCAB has become a procedure that can be performed without support in the majority of the cases. Nevertheless, the concept of miniaturization and the possibility to insert these devices through a peripheral access has opened the way to new indications, mainly short-term circulatory support for acute heart failure. This development is welcome in a field where available devices are invasive and plagued with a heavy morbidity.