Coronary Artery Bypass Grafting on Microaxial Flow Pump Support in Patients With Severely Reduced Left Ventricular
Gaik Nersesian1,2, Daniel Lewin1, Yuriy Hrytsyna1
1Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany.
Insights
Microaxial flow pump (mAFP) support during coronary artery bypass grafting (CABG) is feasible for high-risk patients with reduced ejection fraction. However, complications like stroke during mAFP manipulation necessitate further research.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Medical Devices
Background:
- Patients with coronary artery disease (CAD) and severely reduced left ventricular ejection fraction (LVEF ≤ 25%) face significant perioperative risks during surgical revascularization.
- This study investigates the outcomes of CAD patients with LVEF ≤ 25% undergoing surgical revascularization with microaxial flow pump (mAFP) support.
Purpose of the Study:
- To evaluate the feasibility and outcomes of using mAFP support during coronary artery bypass grafting (CABG) in high-risk patients with severely reduced LVEF.
- To identify complications associated with mAFP support in this patient population.
Main Methods:
- Retrospective analysis of 12 patients undergoing scheduled protected coronary artery bypass grafting (CABG) with full-flow mAFP support.
- Exclusion of patients with acute myocardial infarction or no myocardial viability.
- Data collection on patient demographics, pre-operative risk scores, surgical details, and post-operative outcomes.
Main Results:
- The cohort (median age 60, 92% male, LVEF 18%) underwent CABG with mAFP support, achieving complete revascularization in 11 cases.
- Myocardial recovery was observed in seven patients; four required durable left ventricular assist device (LVAD) implantation, and one died on mAFP support.
- Complications included bleeding, mAFP device issues (thrombosis/dislodgement), and four thromboembolic strokes in three patients during mAFP manipulation. Overall mortality was 16.6% within 93 days.
Conclusions:
- Surgical revascularization with mAFP support is a feasible option for high-risk CAD patients with severely reduced LVEF.
- Support-related complications, particularly thromboembolic strokes during mAFP manipulation, are significant concerns.
- Prospective randomized trials are crucial to compare intraoperative mAFP support with other strategies and validate its benefits.
Introduction:
Patients with coronary artery disease (CAD) and severely reduced left ventricular ejection fraction (LVEF) face high perioperative risks during surgical revascularization. This case series examines outcomes in CAD patients with LVEF ≤ 25% undergoing surgical revascularization on microaxial flow pump (mAFP) support.
Methods:
We retrospectively analyzed 12 patients at Deutsches Herzzentrum der Charité who underwent scheduled protected coronary artery bypass grafting (CABG) with full-flow mAFP support. Patients with acute myocardial infarction or no myocardial viability were excluded.
Results:
The cohort had a median age of 60 years [59; 66], 92% male, BMI 26 ± 6.2 kg/m2, median LVEF 18% [15; 24], and LVEDD 69 mm [59; 78]. Seven patients had diabetes mellitus and chronic renal failure, and five had prior myocardial infarctions. The mean EUROSCORE II was 2.5 ± 0.6. Surgical revascularization was performed with ongoing mAFP support, with a median of 3 distal anastomoses. Complete revascularization was achieved in 11 cases and surgical time was 254 min [187; 266]. Myocardial recovery occurred in seven patients, while four required durable left ventricular assist device implantation, and one died on mAFP support. Two (16.6%) patients died during a follow-up period of 93 days. Median Impella support lasted 6 days [3; 9], invasive ventilation 13 h [11; 20], and ICU stays 4.5 days [4; 17]. Complications included one bleeding requiring revision, two mAFP exchanges due to thrombosis/dislodgement, and four thromboembolic strokes in three patients during mAFP explantation/exchange.
Conclusion:
Revascularization with mAFP support is a feasible approach for high-risk CAD patients but is associated with support-related complications, including thromboembolic strokes during mAFP manipulations (e.g., explantation or exchange). Prospective randomized trials are essential to evaluate the potential benefits of intraoperative mAFP support during surgical revascularization compared to alternative mechanical support strategies and/or pharmacological measures.
