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

Abstract

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.

Coronary artery bypass grafting in left ventricular dysfunction: when and how

“…Two very small series from the United States and Europe reported excellent results in patients who underwent CABG with low ejection fraction after receiving preemptive perioperative Impella (5.0, 5.5) [17,18].…”

Programmatic approach to patients with advanced ischemic cardiomyopathy: Integrating microaxial support into strategies for the modern era

“…35,36 More recently, the preoperative placement of an axillary Impella 5.5 (Abiomed, Danvers, MA) temporary LVAD has become an increasingly utilized preoperative optimization strategy for highrisk CABG candidates. 37 vasopressors, extracorporeal membrane oxygenation (ECMO), and intra-aortic balloon pumps (IABP). While inotropic agents increase cardiac output, they also increase myocardial oxygen consumption, which is unfavorable for an already dysfunctional LV.…”

“…For those patients who remain insufficiently optimized with medical therapy alone, placement of an IABP has been demonstrated to improve postoperative survival and reduce the incidence of LCOS following cardiac surgery 35,36 . More recently, the preoperative placement of an axillary Impella 5.5 (Abiomed, Danvers, MA) temporary LVAD has become an increasingly utilized preoperative optimization strategy for high‐risk CABG candidates 37,38 …”

Temporary mechanical circulatory support & enhancing recovery after cardiac surgery

“…The spectrum of tMCS use in adult cardiac surgery commonly includes bridge to surgery, proactive support for patients with high risk of postcardiotomy cardiogenic shock (PCCS), which ranges from 2% to 14% of procedures and the associated 12–25 times increased mortality [29,30 ▪ ,31,32], and reactive assistance for failure to separate from cardiopulmonary bypass (CPB) [33] or rescuing patients suffering from PCCS [34 ▪▪ ,35].…”