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Published on: May 11, 2018
Intracardiac left ventricular support in beating heart, multi-vessel revascularization
Frank Isgro1, Arndt H Kiessling, Erik Rehn
1Clinic for Cardiac Surgery, Heart Institute Ludwigshafen, Germany.
Insights
A microaxial pump (Impella) in the left ventricle significantly reduced conversion rates during off-pump coronary revascularization. This device supports complete revascularization in nearly all patients, improving surgical outcomes.
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.
Background:
Less invasive operation procedures without support of extracorporeal circulation are becoming increasingly important. A basic requirement for good long-term results in such cases is, however, the complete revascularization of the affected coronary vessels. The unsatisfactorily high conversion rate from bypass operations originally planned as off-pump to conventional operations with heart-lung machines, because of the failure to reach the target vessels on the rear wall of the heart through hemodynamic instability led to investigation of the efficiency of a microaxial pump (Impella elect) placed in the left ventricle.
Methods:
In a prospective project 15 of 38 consecutive patients selected for coronary revascularization with beating heart had a micro pump transaortically implanted in the left ventricle to support the heart during the operation with a flow rate of 2.5 to 3.9 l/min.
Results:
With 8 of 23 patients operated on without pump support, the operation had to be converted to conventional methods with a heart-lung machine. Only one patient out of the left-ventricle-supported group had to be further operated on conventionally because of a deep intramyocardial positioned left anterior descending coronary artery (LAD) (p < 0.05). The investigated laboratory parameters, especially creatine kinase (CK), CK-MB isoenzyme, and clotting showed no significant difference. There tended to be a higher blood loss recorded with the pump-supported patients.
Conclusion:
In summary, it appeared that the application of a left ventricular coaxial pump with comparable results seemed to make possible complete revascularization in nearly all patients.
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