Ranganath Neel K, Nafday Heidi B, Zias Elias, Hisamoto Kazuhiro, Chen Stacey, Kon Zachary N, Galloway Aubrey C, Moazami Nader, Smith Deane E
Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York.
J Card Surg. 2019 Dec;34(12):1569-1572. doi: 10.1111/jocs.14295. Epub 2019 Oct 26.
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.
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).
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.
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.
接受高风险冠状动脉旁路移植术（CABG）且左心室射血分数（LVEF）较低的患者，术后发生心源性休克的风险增加。本报告描述了计划同期置入微轴临时机械支持（MA-TMS）装置，作为接受手术血运重建的高风险患者可行的过渡到康复的策略。
对2017年10月至2019年5月期间在单一机构接受CABG并接受预防性MA-TMS支持的所有患者进行回顾性研究，这些患者LVEF较低（<30%），纽约心脏协会心功能分级为III或IV级，且存在心肌存活（n = 13）。
患者平均年龄为64.8岁，12例患者（92%）为男性。8例患者（62%）表现为急性冠状动脉综合征。预测的平均死亡风险为4.6%，范围为0.6%至15.6%。每位患者平均进行3.4根血管移植。超过60%的患者在48小时内拔管，72小时内下床，MA-TMS的平均持续时间为5.7天。术后平均住院时间为16.7天。术后无心肌梗死或死亡病例。
对于可能接受持久心室辅助装置的严重左心室功能障碍患者，预防性MA-TMS可能使手术血运重建安全有效。
