Preemptive Impella 5.5 insertion to reduce operative risk in high-risk cardiac surgery: A case report

Society of thoracic surgery (STS) risk score has been used as a tool to gauge operative risk of cardiac surgery patients. High-risk patients, with STS risk score > 8 %, are considered as having prohibitive risk and are not offered surgery. There is no established strategy to minimize postoperative hemodynamic instability using mechanical circulatory support (MCS), despite growing interest in utilizing MCS prior to hemodynamic instability. The Impella 5.5 can provide enough perfusion and unload the left ventricle.

We managed a 75-year-old male with multiple comorbidities and a presumed Society of Thoracic Surgeons (STS) score higher than 9.8 %, who had redo coronary artery bypass grafting and aortic and mitral valve replacement with concomitant implantation of the Impella 5.5. Patient had a good recovery despite developing post-operative atrial fibrillation.

Impella is used as a mechanical circulatory support device in patients with cardiogenic shock. It provides forward flow and effectively unloads the left ventricle. The concomitant placement of the Impella 5.5 in high-risk cardiac candidates may be associated with reduced operative risk.

Placement of the device as part of surgical plan can potentially mitigate the perioperative risk by providing adequate endogean perfusion, decrease pressor support, unloading LV.