Intracardiac left ventricular support in beating heart, multi-vessel revascularization

Area of Science:

• Cardiovascular Surgery
• Minimally Invasive Procedures
• Medical Device Technology

Background:

• Off-pump coronary artery bypass grafting (CABG) aims for less invasive procedures without cardiopulmonary bypass.
• Complete revascularization is crucial for long-term outcomes in off-pump CABG.
• High conversion rates to conventional surgery due to hemodynamic instability and difficulty accessing posterior vessels necessitate improved techniques.

Purpose of the Study:

• To evaluate the efficacy of a microaxial pump (Impella) in supporting off-pump coronary revascularization.
• To determine if left ventricular pump support can reduce conversion rates to cardiopulmonary bypass.
• To assess the impact of pump support on achieving complete revascularization.

Main Methods:

• A prospective study involving 38 consecutive patients undergoing off-pump CABG.
• 15 patients received a microaxial pump (Impella) implanted transaortically into the left ventricle.
• Pump support provided a flow rate of 2.5 to 3.9 L/min during the procedure.

Main Results:

• Only 1 of 15 pump-supported patients required conversion to cardiopulmonary bypass, compared to 8 of 23 non-supported patients (p < 0.05).
• Complete revascularization was achieved in nearly all pump-supported patients.
• No significant differences were observed in laboratory parameters (CK, CK-MB, clotting); however, pump-supported patients showed a trend toward higher blood loss.

Conclusions:

• Left ventricular microaxial pump application facilitates complete coronary revascularization in nearly all patients.
• The use of this device significantly reduces the need for conversion to cardiopulmonary bypass during off-pump CABG.
• Comparable surgical results can be achieved with improved procedural success rates.