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[A case of right ventricular failure after CABG successfully supported by right heart bypass with a centrifugal pump]
Insights
Right heart bypass (RHB) effectively supported a patient with right ventricular failure after coronary artery bypass grafting (CABG). This method allowed successful weaning from cardiopulmonary bypass (CPB), demonstrating its reliability in critical cardiac surgery scenarios.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery
- Mechanical Circulatory Support
Background:
- Severe triple vessel disease necessitates coronary artery bypass grafting (CABG).
- Right ventricular failure can occur post-CABG, complicating weaning from cardiopulmonary bypass (CPB).
- Perioperative right ventricular infarction is a potential cause of RV dysfunction.
Observation:
- A 67-year-old female patient developed refractory right ventricular failure post-CABG.
- Standard inotropic support and intra-aortic balloon pump (IABP) were insufficient to wean from CPB.
- Right heart bypass (RHB) using a centrifugal pump was initiated.
Findings:
- RHB successfully facilitated weaning from CPB, allowing for an uneventful postoperative recovery apart from mediastinitis.
- Systemic heparinization maintained activated clotting time (ACT) between 180-200 seconds during the 5-day RHB support.
- The patient demonstrated successful recovery with RHB support.
Implications:
- Right heart bypass with a centrifugal pump is a viable and reliable option for managing acute right ventricular failure after cardiac surgery.
- This approach can prevent prolonged CPB support and improve patient outcomes in complex cardiac surgical cases.
- RHB offers a crucial mechanical circulatory support strategy for RV dysfunction in the perioperative setting.
Abstract:
A 67-year-old woman underwent CABG because of severe triple vessel disease. She could not wean from CPB in spite of full inotropic drugs and IABP support due to right ventricular failure probably caused by the perioperative right ventricular infarction. Right heart bypass (RHB) with a centrifugal pump was used. Finally she could wean from CPB and took an uneventful postoperative course except mediastinitis. During 5 days of RHB operation ACT was maintained between 180s and 200s by systemic heparinization. RHB with a centrifugal pump is a reliable method to assist a failing right ventricle.