Device-supported myocardial revascularization: safe help for sick hearts.

Area of Science:

• Cardiovascular Surgery
• Medical Technology
• Critical Care Medicine

Background:

• Aortocoronary bypass surgery has advanced, but efficacy is limited in severely ill patients.
• Intraoperative hemodynamic support and ventricular decompression are crucial for high-risk cardiac procedures.

Purpose of the Study:

• To evaluate the safety and efficacy of aortocoronary bypass using ventricular assist devices (VADs) in severely ill patients.
• To assess the impact of VAD support on cardiac function and outcomes in complex revascularization.

Main Methods:

• Forty-three severely ill patients underwent aortocoronary bypass with VAD support (Nimbus Hemopumps or Bio-Medicus centrifugal VADs).
• Operations were performed on beating hearts without cardioplegia or cardiopulmonary bypass, utilizing the patient's lungs as the oxygenator.
• Average VAD support duration was 112 minutes, with an average of 3.7 bypass grafts constructed per patient.

Main Results:

• Two patients (4.6%) died postoperatively; one from low cardiac output and another from a neurologic deficit.
• All surviving patients showed improved cardiac function in early and late follow-up periods (average 8.9 months).
• Preoperative ejection fractions averaged 0.22 in 34 patients, with 6 experiencing cardiogenic shock.

Conclusions:

• Ventricular assist devices provide effective intraoperative hemodynamic support and ventricular decompression during aortocoronary bypass in high-risk patients.
• This approach facilitates successful myocardial revascularization on beating hearts, leading to improved cardiac function post-surgery.
• The technique demonstrates a low mortality rate and significant functional recovery in a severely ill patient cohort.