Temporary circulatory support with surgically implanted microaxial pumps in postcardiotomy cardiogenic shock following coronary artery bypass surgeryCentral MessagePerspective

Wiebke Sommer, MD; Rawa Arif, MD; Jamila Kremer, MD; Sameer Al Maisary, MD; Markus Verch, MD; Ursula Tochtermann, MD; Matthias Karck, MD; Anna L. Meyer, MD; Gregor Warnecke, MD

JTCVS Open (Sep 2023)

Temporary circulatory support with surgically implanted microaxial pumps in postcardiotomy cardiogenic shock following coronary artery bypass surgeryCentral MessagePerspective

Wiebke Sommer, MD,
Rawa Arif, MD,
Jamila Kremer, MD,
Sameer Al Maisary, MD,
Markus Verch, MD,
Ursula Tochtermann, MD,
Matthias Karck, MD,
Anna L. Meyer, MD,
Gregor Warnecke, MD

Affiliations

Wiebke Sommer, MD: Address for reprints: Wiebke Sommer, MD, Department of Cardiac Surgery, University of Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany.; Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
Rawa Arif, MD: Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
Jamila Kremer, MD: Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
Sameer Al Maisary, MD: Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
Markus Verch, MD: Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
Ursula Tochtermann, MD: Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
Matthias Karck, MD: Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
Anna L. Meyer, MD: Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
Gregor Warnecke, MD: Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany

Journal volume & issue: Vol. 15
pp. 252 – 260

Abstract

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Objectives: Patients with ischemic cardiomyopathy undergoing coronary artery bypass grafting (CABG) surgery may develop postcardiotomy cardiogenic shock. In these cases, implantation of an Impella 5.0 or 5.5 microaxial pump offers full hemodynamic support while simultaneously unloading of the left ventricle. Methods: Preoperative, perioperative, and postoperative data of all patients receiving postoperative support with an Impella 5.0 or 5.5 after CABG surgery between September 2017 and October 2022 were retrospectively collected. Cohort built-up was performed according to the timing of Impella implantation, either simultaneous during CABG surgery or delayed. Results: A total of n = 42 patients received postoperative Impella support, of whom 27 patients underwent simultaneous Impella implantation during CABG surgery and 15 patients underwent delayed Impella therapy. Preoperative left ventricular ejection fraction was similarly low in both groups (26.7 ± 0.7% vs 24.8 ± 11.3%; P = .32). In the delayed cohort, Impella implantation was performed after a median of 1 (1; 2) days after CABG surgery. Survival after 30 days (75.6% vs 47.6%, P = .04) and 1 year (69.4% vs 29.8%, P = .03) was better in the cohort receiving simultaneous Impella implantation. Conclusions: The combined advantages of hemodynamic support and LV unloading with microaxial pumps may lead to a favorable survival in patients with left ventricular failure following CABG surgery. Early implantation during the initial surgery shows a trend toward a more favorable survival as compared with patients receiving delayed support.

Published in JTCVS Open

ISSN: 2666-2736 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the circulatory (Cardiovascular) system; Medicine: Surgery
Website: https://www.journals.elsevier.com/jtcvs-open

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