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Temporary circulatory support with surgically implanted microaxial pumps in postcardiotomy cardiogenic shock

Wiebke Sommer1, Rawa Arif1, Jamila Kremer1

  • 1Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany.

JTCVS Open
|October 9, 2023
PubMed

Insights

Simultaneous Impella 5.0/5.5 pump implantation during coronary artery bypass grafting (CABG) surgery improves survival in patients with ischemic cardiomyopathy compared to delayed implantation. Early hemodynamic support is key for better outcomes.

Area of Science:

  • Cardiovascular Surgery
  • Mechanical Circulatory Support
  • Cardiac Surgery Outcomes

Background:

  • Post-cardiotomy cardiogenic shock is a risk for patients with ischemic cardiomyopathy undergoing coronary artery bypass grafting (CABG).
  • Microaxial pumps like Impella 5.0/5.5 offer full hemodynamic support and left ventricular unloading.
  • These devices can be crucial for managing severe left ventricular failure post-CABG.

Purpose of the Study:

  • To evaluate the impact of the timing of Impella 5.0/5.5 implantation on patient survival.
  • To compare outcomes between simultaneous (during CABG) and delayed Impella implantation.
  • To assess the efficacy of microaxial pumps in patients with postcardiotomy cardiogenic shock.

Main Methods:

  • Retrospective analysis of 42 patients receiving Impella 5.0/5.5 support post-CABG (Sept 2017 - Oct 2022).
  • Patients were divided into two groups: simultaneous implantation during CABG and delayed implantation.
  • Preoperative, perioperative, and postoperative data were collected and analyzed.

Main Results:

  • Simultaneous implantation (n=27) showed significantly better 30-day survival (75.6% vs 47.6%, P=0.04) and 1-year survival (69.4% vs 29.8%, P=0.03) compared to delayed implantation (n=15).
  • Preoperative left ventricular ejection fraction was similarly low in both groups, indicating comparable baseline severity.
  • Delayed Impella implantation occurred a median of 1 day after CABG surgery.

Conclusions:

  • Combined hemodynamic support and left ventricular unloading with Impella pumps can improve survival in post-CABG left ventricular failure.
  • Early implantation of Impella during the initial CABG surgery demonstrates a trend towards more favorable survival outcomes.
  • This suggests that timely initiation of mechanical circulatory support is critical for managing severe cardiac dysfunction post-surgery.
Abstract

Keywords:
CABG surgeryImpella 5.0Impella 5.5LV unloadingischemic cardiomyopathypostcardiotomy cardiogenic shocktemporary mechanical support

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