Concomitant temporary mechanical support in high‐risk coronary artery bypass surgery

Abstract

Objectives: Patients with low left ventricular ejection fraction (LVEF) undergoing high-risk coronary artery bypass grafting (CABG) are at increased risk for postcardiotomy cardiogenic shock. This report describes planned concomitant microaxial temporary mechanical support (MA-TMS) device placement as a viable bridge-to-recovery strategy for high-risk patients receiving surgical revascularization.Methods: A retrospective review was performed for all patients from October 2017 to May 2019 with low LVEF (<30%), New York Heart Association Class III or IV symptoms, and myocardial viability who underwent CABG with prophylactic MA-TMS support at a single institution (n = 13).Results: Mean patient age was 64.8 years, and 12 patients (92%) were male. Eight patients (62%) presented with acute coronary syndrome. Mean predicted risk of mortality was 4.6%, ranging from 0.6% to 15.6%. An average of 3.4 grafts were performed per patient. Greater than 60% of patients were extubated within 48 hours and out-of-bed within 72 hours, and the average duration of MA-TMS was 5.7 days.Mean postoperative length of stay was 16.7 days. There were no postoperative myocardial infarctions or deaths.Conclusions: Prophylactic MA-TMS may allow safe and effective surgical revascularization for patients with severe left ventricular dysfunction who may otherwise be offered a durable ventricular assist device. K E Y W O R D Scoronary artery bypass, mechanical circulatory support, temporary circulatory support

Temporary mechanical circulatory support prevents the occurrence of a low‐output state in high‐risk coronary artery bypass grafting: A case series

“…The most recent experiences with microaxial tMCS in high‐risk CABG has centered on postoperative recovery. In a case series of 13 high‐risk patients undergoing on‐pump CABG, postoperative microaxial support for recovery allowed for early ambulation (61.5% out of bed in < 72 h) and extubation (61.5% in < 48 h) with no in‐hospital mortalities 19 . Average length of stay (16.7 days), reoperation for bleeding (30.8%), and duration of tMCS (5.7 days) were similar to that observed in the present series.…”

Activation of alpha-4 beta-2 nicotinic receptor against cardiopulmonary bypass surgery induced brain injury by regulating NLRP3 pathway

“…Cardiopulmonary bypass (CPB) technology is used for the treatment of several types of cardiovascular disorder by surgery and reported to reduces the mortality occurs due to cardiovascular issues (Ranganath et al, 2019). However CPB reported to induces the injury to different organs of the body including brain (Kim et al, 2016).…”

Algorithmic management of postcardiotomy shock with mechanical support: Bring a map, a plan, and your parachute—and know how to use all three

“…Enhanced perfusion with an IABP or percutaneous left ventricular assist device (LVAD) inserted via an axillary artery may improve renal function and reverse metabolic derangements, while allowing ambulation and providing meaningful improvement to the patient's risk profile. 7 Some patients presenting with hemodynamic decompensation and an indication for emergency surgery will benefit from preoperative resuscitation and stabilization on VA-ECMO. Hemodynamic stability provided by preoperative MCS allows time to determine whether end-organ damage is reversible.…”