Intracardiac Left Ventricular Support in Beating Heart, Multi-vessel Revascularization

• Published in: Journal of cardiac surgery Vol. 18; no. 3; pp. 240 - 244
• Main Authors: Isgro, Frank, Kiessling, Arndt-H., Rehn, Erik, Lang, Johannes, Saggau, Werner
• Format: Journal Article
• Language: English
• Published: 350 Main Street , Malden , MA 02148 , USA. , and 9600 Garsington Road , Oxford OX4 2DQ , UK Blackwell Science Inc 01.05.2003
• Subjects: Aged; Cardiopulmonary Bypass - methods; Coronary Artery Bypass - instrumentation; Coronary Artery Bypass - methods; Coronary Disease - pathology; Coronary Disease - surgery; Coronary Vessels - pathology; Coronary Vessels - surgery; Equipment Design; Equipment Safety; Female; Heart Function Tests; Heart-Assist Devices; Hemodynamics - physiology; Humans; Intra-Aortic Balloon Pumping; Male; Middle Aged; Myocardial Revascularization - instrumentation; Myocardial Revascularization - methods; Probability; Prognosis; Prospective Studies; Risk Assessment; Severity of Illness Index; Treatment Outcome; Ventricular Dysfunction, Left - therapy
• ISSN: 0886-0440; 1540-8191
• DOI: 10.1046/j.1540-8191.2003.02022.x

Background: Less invasive operation procedures without support of extracorporeal circulation are becoming increasingly important. A basic requirement for good long‐term results in such cases is, however, the complete revascularization of the affected coronary vessels. The unsatisfactorily high conversion rate from bypass operations originally planned as off‐pump to conventional operations with heart‐lung machines, because of the failure to reach the target vessels on the rear wall of the heart through hemodynamic instability led to investigation of the efficiency of a microaxial pump (Impella elect) placed in the left ventricle. Methods: In a prospective project 15 of 38 consecutive patients selected for coronary revascularization with beating heart had a micro pump transaortically implanted in the left ventricle to support the heart during the operation with a flow rate of 2.5 to 3.9 l/min. Results: With 8 of 23 patients operated on without pump support, the operation had to be converted to conventional methods with a heart‐lung machine. Only one patient out of the left‐ventricle‐supported group had to be further operated on conventionally because of a deep intramyocardial positioned left anterior descending coronary artery (LAD) (p < 0.05). The investigated laboratory parameters, especially creatine kinase (CK), CK‐MB isoenzyme, and clotting showed no significant difference. There tended to be a higher blood loss recorded with the pump‐supported patients. Conclusion: In summary, it appeared that the application of a left ventricular coaxial pump with comparable results seemed to make possible complete revascularization in nearly all patients. (J Card Surg 2003;18:240‐244)