Mechanical support for high-risk coronary artery bypass grafting

Ali, Jason M.; Abu‐Omar, Yasir

doi:10.1007/s12055-018-0740-1

Cited by 7 publications

(5 citation statements)

References 49 publications

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“…MCS can also be used in the case of intraoperative failure to wean the patient from cardiopulmonary bypass [6]. AMI-patients with ECMO-start after CABG had the lowest 30-day-survival (40.7%), whereas preoperative and intraoperative ECMO-start was associated with significantly better survival reaching up to 66.7% [7,8]. There are several forms of MCS that can be utilized; for example, IABP, VA-ECMO, and ventricular assist devices (VAD).…”

Section: Discussionmentioning

confidence: 99%

Application of ECMO in a Patient with Post-Cardiotomy Cardiogenic Shock Combined with Dextrocardia: Case Report

2023

IJCMER

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Venous-arterial extracorporeal membrane oxygenation (VA-ECMO) is a widely-accepted salvage therapy for patients with refractory cardiogenic shock (CS). CS often presents with mirror-image dextrocardia and other cardiac abnormalities, making surgical management of CS challenging. The use of VA-ECMO and an intra-aortic balloon pump (IABP) to address CS combined with dextrocardia has not been reported previously. In this case report, we summarize our experience treating perioperative CS using VA-ECMO and IABP in a male patient with dextrocardia combined with coronary artery disease (CAD). During off-pump coronary artery bypass (OPCAB), the patient developed CS and underwent emergency transfer to on-pump coronary artery bypass (ONCAB). The patient then received ECMO and an IABP, which successfully restored hemodynamic function. The patient was eventually discharged from the hospital without further complications.

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Section: Discussionmentioning

confidence: 99%

Application of ECMO in a Patient with Post-Cardiotomy Cardiogenic Shock Combined with Dextrocardia: Case Report

2023

IJCMER

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“…Once in need of ECLS due to PCS, their mortality rate increases to 50-80% [1]. Associated complications such as a major neurological event, renal failure requiring hemofiltration, lower limb ischemia and reoperation due to mediastinal bleeding are common [9].…”

Section: Discussionmentioning

confidence: 99%

Preventive Impella® Support in High-Risk Patients Undergoing Cardiac Surgery

Benke

Korça

Boltjes

et al. 2022

JCM

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Background: Patients with severely reduced LV-EF ≤ 30% undergoing CABG have a high risk for postoperative cardiogenic shock. The optimal timing of an adequate hemodynamic support has an impact on short- and midterm mortality after CABG. This study aimed to assess the prophylactic use of the Impella pump in high-risk patients undergoing elective cardiac surgery. Methods: In this single-center retrospective study, 14 patients with LV-EF (≤30%) undergoing cardiac surgery received a prophylactic, perioperative Impella (5.0, 5.5) support between 2020 and 2022. Results: The mean age at surgery was 64.2 ± 2.6 years, the mean preoperative LV-EF was 20.7% ± 1.56%. The duration of Impella support was 4 (3–7.8) days and the 30-day survival rate was 92.85%. Acute renal failure occurred in four patients who were dialyzed on average for 1.2 ± 0.7 days. Mechanical ventilation was needed for 1.75 (0.9–2.7) days. Time to inotrope/vasopressor independence was 2 (0.97–7.25) days with a highest lactate level (24 h postoperatively) of 3.8 ± 0.6 mmol/l. Postoperative LV-EF showed a significant improvement when compared to preoperative LV-EF (29.1% ± 2.6% vs. 20.7% ± 1.56% (p = 0.022)). Conclusion: The prophylactic Impella application seems to be a safe approach to improve the outcomes of this patient population.

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“…Its first use was in the 1960s following the work of Kantrowitz who identified that ‘diastolic augmentation’ could be utilised to improve myocardial oxygenation. The IABP is the most readily available form of mechanical support and as such the indications for use are wide in the context of patients undergoing CABG ( 2 ). In one study the outcome after insertion IABP was followed by measuring renal fuction.…”

Section: Discussionmentioning

confidence: 99%

“…Prophylactic and postoperative administration of IABP is recommended, which is commonly used in high-risk patients undergoing cardiac surgery or percutaneous coronary intervention. The IABP is the most readily available form of mechanical support and as such the indications for use are wide in the context of patients undergoing CABG: Cardiogenic shock, unstable angina, prophylactically, to facilitate weaning from CPB and for postoperative LCOS–low cardiac output syndrome ( 2 ).…”

Section: Introductionmentioning

confidence: 99%

Inotropic and Mechanical Support of Critically Ill Patient after Cardiac Surgery

et al. 2020

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Introduction: Cardiac surgery patients often need inotropic support to establish hemodynamic stability and adequate oxygen supply. The management of patients with coronary vascular disease can be challenging especially in patients with severe left ventricular dysfunction and critical left main or severe triple vessel disease. Methods: Article has descriptive character and presents a case report of 58 years old male patient who was admitted to our hospital due to planned coronary bypass surgery. Results: Applying inotropic support, IABP and adequate volume management during surgery and post surgery period in ICU has led to hemodynamic stability. Leading to the recovery of the patient and hospital discharge. Discussion: Given the availability of the treatment options, inotropic and mechanical support played a major role to produce the positive outcome in the presented case. Many factors were unfavourable, extreme hypotension, high lactate and creatining levels, mechanical ventilation and related complications.

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Mechanical support for high-risk coronary artery bypass grafting

Cited by 7 publications

References 49 publications

Application of ECMO in a Patient with Post-Cardiotomy Cardiogenic Shock Combined with Dextrocardia: Case Report

Application of ECMO in a Patient with Post-Cardiotomy Cardiogenic Shock Combined with Dextrocardia: Case Report

Preventive Impella® Support in High-Risk Patients Undergoing Cardiac Surgery

Inotropic and Mechanical Support of Critically Ill Patient after Cardiac Surgery

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