Faculty Collaboration Database

Temporary mechanical circulatory support prevents the occurrence of a low-output state in high-risk coronary artery bypass grafting: A case series. J Card Surg 2021 Mar;36(3):864-871

Date

01/12/2021

Pubmed ID

33428241

DOI

10.1111/jocs.15309

Scopus ID

2-s2.0-85099081264 (requires institutional sign-in at Scopus site)   5 Citations

Abstract

BACKGROUND: Coronary artery bypass grafting (CABG) is a durable treatment for coronary artery disease. Left ventricular dysfunction (LVD) (a division of cardiothoracic surgery) (ejection fraction < 35%) significantly elevates perioperative risk for patients pursuing surgical revascularization. Periprocedural support with temporary mechanical circulatory support (tMCS) has shown benefit in this patient population.

METHODS: Four patients with ischemic cardiomyopathy and LVD underwent CABG at our institution between 2017 and 2018. Each patient received perioperative ventricular support using a microaxial tMCS device (Impella 5.0®). The occurrence of a postoperative low-output state (LOS) was assessed for as well as postoperative morbidity and mortality, device-specific complications, and tMCS support duration.

RESULTS: All patients survived to device explant without device-related complications. Two patients required reoperation for nondevice-related bleeding. All patients were without an LOS at 24 h postoperatively with cardiac indices of 2.9-3.6 L/min/m² , normalized serum lactate, and vasoactive-inotrope scores of 0-12.0. There was a notably high incidence of acute renal failure (50%), which was observed in patients with preoperative cardiogenic shock. One patient died 10 days after the device explant. Of the three patients that survived to discharge, two were alive at the most recent follow-up. Postoperative device support varied widely (0-500 h).

CONCLUSION: Perioperative tMCS may be a viable strategy for preventing postoperative LOS in high-risk CABG patients with a low complication rate and acceptable morbidity. The application of microaxial tMCS devices in CABG is an area that warrants further investigation to delineate its impact on perioperative outcomes and potentially expand the indications for such devices.

Author List

Smith NJ, Ramamurthi A, Joyce LD, Durham LA, Kohmoto T, Joyce DL

Authors

Lucian A. Durham MD, PhD Associate Professor in the Surgery department at Medical College of Wisconsin
Takushi Kohmoto MD, PhD Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Coronary Artery Bypass
Coronary Artery Disease
Humans
Shock, Cardiogenic
Treatment Outcome
Ventricular Dysfunction, Left